Affiliations: [a] German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| [b] Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald (UMG), Greifswald, Germany
| [c] Program for Health Economics and Outcome Measures (PHENOM), Hamilton, Canada
| [d] Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, Canada
Correspondence:
[*]
Correspondence to: Anika Rädke, German Center for Neurodegenerative Diseases (DZNE),
Ellernholzstraße, 1-2, 17489, Greifswald, Germany. Tel.: +49 3834 86 75 07;
E-mail: anika.raedke@dzne.de.
Abstract: Background:Dementia care management (DCM) aims to provide optimal treatment for people with dementia (PwD). Treatment and care needs are dependent on patients’ sociodemographic and clinical characteristics and thus, economic outcomes could depend on such characteristics. Objective:To detect important subgroups that benefit most from DCM and for which a significant effect on cost, QALY, and the individual cost-effectiveness could be achieved. Methods:The analysis was based on 444 participants of the DelpHi-trial. For each subgroup, the probability of DCM being cost-effective was calculated and visualized using cost-effectiveness acceptability curves. The impact of DCM on individual costs and QALYs was assessed by using multivariate regression models with interaction terms. Results:The probability of DCM being cost-effective at a willingness-to-pay of 40,000€ /QALY was higher in females (96% versus 16% for males), in those living alone (96% versus 26% for those living not alone), in those being moderately to severely cognitively (100% versus 3% for patients without cognitive impairment) and functionally impaired (97% versus 16% for patients without functional impairment), and in PwD having a high comorbidity (96% versus 26% for patients with a low comorbidity). Multivariate analyses revealed that females (b = –10,873; SE = 4,775, p = 0.023) who received the intervention had significantly lower healthcare cost. DCM significantly improved QALY for PwD with mild and moderate cognitive (b = +0.232, SE = 0.105) and functional deficits (b = +0.200, SE = 0.095). Conclusion:Patients characteristics significantly affect the cost-effectiveness. Females, patients living alone, patients with a high comorbidity, and those being moderately cognitively and functionally impaired benefit most from DCM. For those subgroups, healthcare payers could gain the highest cost savings and the highest effects on QALYs when DCM will be implemented.
Keywords: Alzheimer’s disease, cost-effectiveness acceptability curve, cost-effectiveness analysis, dementia, economic evaluation, health care costs, individual cost-effectiveness ratio, net benefit regression, net monetary benefit
