Private costs almost equal health care costs when intervening in mild Alzheimer's: a cohort study alongside the DAISY trial

Atenção à saúde na síndrome demencial: qual será o impacto econômico dessa atenção no Brasil?

O estudo pretende chamar a atenção dos tomadores de decisão para a premente necessidade da avaliação do impacto econômico da síndrome demencial no Brasil. O País já se enquadra, em termos demográficos e epidemiológicos, em patamar semelhante ao dos países desenvolvidos, mas ainda não implementou de forma efetiva políticas públicas ou reconheceu as reais necessidades sociais em saúde para a configuração dessa atual condição. Para tanto, uma revisão não sistemática sobre o impacto financeiro da síndrome em várias regiões do mundo foi elaborada. Diante das evidências, concluiu-se que é de suma importância a realização de estudos empíricos no contexto brasileiro que contemplem essa temática.

Cost analysis of early psychosocial intervention in Alzheimer's disease

BACKGROUND/AIM

To investigate the impact of early psychosocial intervention aimed at patients with Alzheimer's disease (AD) and their caregivers on resource use and costs from a societal perspective.

METHODS

Dyads of patients and their primary caregiver were randomised to intervention (n = 163) or control (n = 167) and followed for 3 years. Health care use was extracted from national registers, and the Resource Utilisation in Dementia questionnaire was used to measure informal care and productivity loss. Multiple imputation was used to replace missing data, and non-parametric bootstrapping was used to estimate standard errors.

RESULTS

Overall, there were no statistically significant differences because of large variation in the observations. The average additional cost of psychosocial intervention provision was estimated at EUR 3,401 per patient. This cost masked a reduced use of formal health care and an increased use of informal care.

CONCLUSIONS

Early psychosocial intervention in AD could be cost-saving from a health care perspective, whereas the opposite seems to be true from a broader societal perspective.

Early psychosocial intervention in Alzheimer's disease: cost utility evaluation alongside the Danish Alzheimer's Intervention Study (DAISY)

OBJECTIVE

To assess the cost utility of early psychosocial intervention for patients with Alzheimer's disease and their primary caregivers.

DESIGN

Cost utility evaluation alongside a multicentre, randomised controlled trial with 3 years of follow-up.

SETTING

Primary care and memory clinics in five Danish districts.

PARTICIPANTS

330 community-dwelling patients and their primary caregivers.

INTERVENTION

Psychosocial counselling and support lasting 8-12 months after diagnosis and follow-up at 3, 6, 12 and 36 months in the intervention group or follow-up only in the control group.

MAIN OUTCOME MEASURES

The primary outcome measure was the cost of additional quality-adjusted life years (QALYs). Costs were measured from a societal perspective, including the costs of healthcare, social care, informal care and production loss. QALYs were estimated separately for the patient and the caregiver before aggregation for the main analysis.

RESULTS

None of the observed cost and QALY measures were significantly different between the intervention and control groups, although a tendency was noted for psychosocial care leading to cost increases with informal care that was not outweighed by the tendency for cost savings with formal care. The probability of psychosocial intervention being cost-effective did not exceed 36% for any threshold value. The alternative scenario analysis showed that the probability of cost-effectiveness increased over the range of threshold values used if the cost perspective was restricted to formal healthcare.

CONCLUSIONS

A multifaceted, psychosocial intervention programme was found unlikely to be cost-effective from a societal perspective. The recommendation for practice in settings that are similar to the Danish setting is to provide follow-up with referral to available local support programmes when needed, and to restrict large multifaceted intervention programmes to patients and caregivers with special needs until further evidence for cost-effectiveness emerges.

TRIAL REGISTRATION

The study was registered in the Clinical Trial Database as ISRCTN74848736.