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86 Interventions in Alzheimer’s Disease KCE Reports 111 Outcomes Costeffectiveness Sensitivity analysis CBT Usual care Successful treatment, % of patients 37% 1.5% CBT versus usual care: - ICosts: -1748 (-4244 – 748) - Difference in % of patients with a successful treatment: 36% (23 – 47) CE plane: The probability that Occupational therapy is a dominant option is 94% Main cost savings: informal care costs, admissions to hospitals, and nursing homes and homes for elderly (institutionalization) Bootstrap analyses to assess the uncertainty of the results but no formal sensitivity analyses Conclusions “Occupational therapy to both patients and caregivers is cost-effective because, on average, it saved €1748 over three months (with a 94% probability), and yielded significant and clinically relevant improvements in daily functioning (patients) and sense of competence (caregiver)” Remarks Study powered to detect a relevant difference in clinical (not economic) outcome. Study Charlesworth G, Shepstone L, Wilson E, Thalanany M, Mugford M, Poland F. Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial. Health Technol Assess. 2008;12(4):iii. Country UK Design RCT-based economic evaluation Probabilistic evaluation (bootstrap) Perspective Societal Time window 15 months Interventions Social support to caregivers: access to a trained befriending facilitator providing one-toone emotional support (companionship and conversation) to the caregiver. The role does not encompass instrumental support or activities aimed at increasing community participation. 6 months or longer intervention on a weekly basis Comparator: usual care, i.e. health, social and voluntary services Population Carers of patients with a primary progressive dementia (not clear how dementia is assessed) 236 carers included Assumptions Efficacy data from the BECCA trial Data source for costs Cost items included Resources used evaluated through questionnaires Costs for both the carers and the patients Costing year: 2005 Direct costs source: national UK references Indirect costs source (time): average UK gross income of the year 2005 Not clearly defined but broadly the following cost categories were included: Intervention’s costs Direct medical costs
KCE Reports 111 Interventions in Alzheimer’s Disease 87 Data source for outcomes Direct non-medical costs Indirect costs - Carer well-being: depression measured by the Hospital Anxiety and Depression Scale (HADS) - Carer health related quality of life: EQ-5D - Patient health related quality of life: EQ-5D (assessed by the carer) Discounting 3.5% for both costs and outcomes of the second year Costs Outcomes Costeffectiveness Sensitivity analysis Befriending Usual care Intervention £1138 (£395) £11 (£65) Other costs … … Informal care time £103 398 (£46 625) £104 918 (£46 708) Total costs £122 665 (£46 843) £120 852 (£45 778) Befriending Usual care HADS score 6.03 (4.00) 6.71 (4.18) QALYs - Carer 0.946 (0.245) 0.929 (0.260) QALYs - Patient 0.365 (0.292) 0.314 (0.317) QALYs – Care & Patient 1.311 (0.416) 1.243 (0.449) Base-case (QoL from the carer) – Befriending + usual care versus usual care alone: - Decrease in HADS score: 0.468 (-0.5; 1.44) - QALYs gained: 0.017 - Incremental costs: £1 813 (-£11 312; £14 984) - Ratio of the mean incremental cost on the mean incremental outcome: £105 954 / QALY gained CEAC: Prob (ICER) < £30 000 = 42.2% Scenario analyses: - QoL from both the carer and the patient o Incremental QALYs: 0.068 (-0.045; 0.185) o Incremental costs: £1 813 (-£11 312; £14 984) o Ratio: £26 848 / QALY gained o CEAC: Prob (ICER) < £30 000 = 51.4% - 24 months follow-up: o Incremental QALYs: 0.024 (-0.083; 0.136) o Incremental costs: £9 191 (-£7 864; £26 377) o Ratio: £380 939 / QALY gained Conclusions There was no significant evidence of effectiveness nor cost-effectiveness from the primary analyses on the ITT population Remarks
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