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<strong>KCE</strong> Reports 111 Interventions in Alzheimer’s Disease 57<br />
The <strong>report</strong>ed incremental cost-effectiveness ratios were between £1200 and £7000 per<br />
year in a non-severe state. The analysis was deterministic so that no confidence<br />
intervals were <strong>report</strong>ed around <strong>the</strong> mean values. Fur<strong>the</strong>r, <strong>the</strong>re was no probabilistic<br />
sensitivity analysis.<br />
5.2.2 Research question 2: Non-pharmacological interventions in AD or<br />
dementia patients<br />
5.2.2.1 Summary of <strong>the</strong> systematic reviews<br />
Patients’ intervention<br />
The systematic review of SBU 21, 111, 113 <strong>report</strong>s that <strong>the</strong>re were only a limited<br />
number of complete economic evaluations of non-pharmaceutical interventions whose<br />
quality was inferior to that of <strong>the</strong> economic evaluations of drug interventions. SBU<br />
reviewed 2 short-term (< 1 year) trial-based 121, 122 and 1 longer-term (8 years) modelbased<br />
123 economic evaluations of non-pharmaceutical interventions aimed at dementia<br />
patients. The programmes of care evaluated were “day care” or “group living”. “Day<br />
care” consisted in providing daily (5–7 hours a day) supervision, kinship and care to <strong>the</strong><br />
AD patient by a trained and professional staff. “Group living” was defined as 24-hour<br />
supervision, kinship and care provided by professional staff in a homelike environment,<br />
where 4–10 people with dementia usually live in a unit. The patients’ AD disease<br />
severity was mild in <strong>the</strong> “day care” programme and mild to moderately severe in <strong>the</strong><br />
“group living” programme, as assessed by <strong>the</strong> clinical examination of a geriatrician.<br />
The results of <strong>the</strong> cost-effectiveness studies were ra<strong>the</strong>r heterogeneous. The two trialbased<br />
economic evaluations could not demonstrate a significant difference in terms of<br />
costs or outcomes (mainly quality of life) between patients “day care” and <strong>the</strong>ir<br />
comparator (usual care), <strong>the</strong>reby implying neutrality in <strong>the</strong> cost-effectiveness of <strong>the</strong><br />
alternatives considered. The model-based study <strong>report</strong>ed dominance of a “group living”<br />
programme over its comparator.<br />
The NICE-SCIE review 1 looked at <strong>the</strong> health economic evidence of non-pharmaceutical<br />
interventions aimed at maintaining <strong>the</strong> cognitive functions of <strong>the</strong> demented patient.<br />
They identified one RCT-based cost-effectiveness study comparing “cognitive<br />
stimulation <strong>the</strong>rapy” (CST) to standard care for UK people with mild to moderate<br />
dementia. 105 The study <strong>report</strong>s a non-significant increase in <strong>the</strong> cost of CST versus<br />
standard care, and a significant improvement in terms of outcome for <strong>the</strong> patient<br />
(MMSE score and QoL-AD). The ICER was £75.3 per additional point on <strong>the</strong> MMSE (£<br />
of <strong>the</strong> year 2001). For <strong>the</strong> quality of life outcome, <strong>the</strong> ICER was £22.8 per additional<br />
point of QoL-AD. NICE-SCIE 1 concludes that this may be reasonable evidence that<br />
providing CST alongside usual care for patients with mild to moderate dementia is likely<br />
to be cost-effective in <strong>the</strong> UK. This conclusion lies however on <strong>the</strong> results of a single<br />
RCT-based evaluation whose time horizon was limited to 8 weeks. 105<br />
Carers’ intervention<br />
SBU 21, 111, 113 reviewed 1 short-term (6 months) trial-based 124 and 2 longer-term (> 5<br />
years) model-based 101, 125 economic evaluations of non-pharmaceutical interventions<br />
targeted at <strong>the</strong> informal carers of demented patients. The programme of care evaluated<br />
was labelled “caregiver support” and consisted in a programme aimed at supporting <strong>the</strong><br />
informal caregivers by providing <strong>the</strong>m counselling, education, emotional support and<br />
opportunities for contact when needed. The patients’ disease severity ranged from mild<br />
to moderately severe.<br />
The trial-based economic evaluation did not find any significant change in terms of costs<br />
or QoL when <strong>the</strong> “caregiver support” programme was adopted, in comparison with<br />
standard care. However, <strong>the</strong> two model-based studies found that “caregiver support”<br />
was a dominant option, i.e. “caregiver support” was both more effective and less costly<br />
than its comparators.<br />
From this, SBU 21, 111, 113 concludes that, since <strong>the</strong> available studies are of limited quality<br />
and size, <strong>the</strong>re is insufficient scientific evidence to assess <strong>the</strong> cost-effectiveness of nonpharmaceutical<br />
programmes for dementia/AD patients or <strong>the</strong>ir carers.