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. 2022 Jan;37(1).
doi: 10.1002/gps.5633. Epub 2021 Oct 15.

What are the current and projected future cost and health-related quality of life implications of scaling up cognitive stimulation therapy?

Martin Knapp  1 , Annette Bauer  1 , Raphael Wittenberg  1 , Adelina Comas-Herrera  1 , Eva Cyhlarova  1 , Bo Hu  1 , Carol Jagger  2 , Andrew Kingston  2 , Anita Patel  3 , Aimee Spector  4 , Audrey Wessel  1 , Gloria Wong  5
Affiliations

What are the current and projected future cost and health-related quality of life implications of scaling up cognitive stimulation therapy?

Martin Knapp et al. Int J Geriatr Psychiatry. 2022 Jan.

Abstract

Objectives: Cognitive stimulation therapy (CST) is one of the few non-pharmacological interventions for people living with dementia shown to be effective and cost-effective. What are the current and future cost and health-related quality of life implications of scaling-up CST to eligible new cases of dementia in England?

Methods/design: Data from trials were combined with microsimulation and macrosimulation modelling to project future prevalence, needs and costs. Health and social costs, unpaid care costs and quality-adjusted life years (QALYs) were compared with and without scaling-up of CST and follow-on maintenance CST (MCST).

Results: Scaling-up group CST requires year-on-year increases in expenditure (mainly on staff), but these would be partially offset by reductions in health and care costs. Unpaid care costs would increase. Scaling-up MCST would also require additional expenditure, but without generating savings elsewhere. There would be improvements in general cognitive functioning and health-related quality of life, summarised in terms of QALY gains. Cost per QALY for CST alone would increase from £12,596 in 2015 to £19,573 by 2040, which is below the threshold for cost-effectiveness used by the National Institute for Health and Care Excellence (NICE). Cost per QALY for CST and MCST combined would grow from £19,883 in 2015 to £30,906 by 2040, making it less likely to be recommended by NICE on cost-effectiveness grounds.

Conclusions: Scaling-up CST England for people with incident dementia can improve lives in an affordable, cost-effective manner. Adding MCST also improves health-related quality of life, but the economic evidence is less compelling.

Keywords: cognitive stimulation therapy; cost; dementia; economic evaluation; quality adjusted life year; scaling-up.

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References

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