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Table 4 Characteristics of articles on psychological and behavioral therapies

From: Health economic evaluations of non-pharmacological interventions for persons with dementia and their informal caregivers: a systematic review

Study, country

Type of study and economic evaluation

Time horizon C: Cost

H: Health outcome

Study population, Number of participants

IG: Intervention group

CG: Control group

Outcome measures (measures of benefit)

Cost data; source

Perspective

Results

Spector [25] UK, 2015

RCT cost analysis

C: 6 months

H: 6 months

Community-dwelling patients with mild-to-moderate dementia and anxiety (N = 50)

▪ 50 randomized participants

▪ 38 participants completed second follow-up assessment

IG: Ten-session cognitive-behavioral therapy for anxiety in dementia

CG: CAU

Primary

▪ RAID

Secondary

▪ CSDD

▪ QoL-AD (self-reported)

▪ NPI

▪ HADS

▪ MMSE

▪ QCPR

CSRI

Health and social care perspective

Significant improvements in depression.

CBT found to be cost neutral.

Laakkonen [24]

Finland, 2016

RCT

CEA

C: 24 months

H: 9 months

Community-dwelling PwDs (shortly after the diagnosis) and their spouses

▪ 136 randomized dyads

▪ 134 completed the follow-up assessment after 9 months

IG: Self-management group rehabilitation for PwDs and their spouses; enhancement of self-efficacy and problem solving skills

CG: CAU and the study nurses gave participants in the control group oral and written advice on nutrition and exercise

Primary

▪ HRQoL: 15D (PwD)

▪ RAND-36 (caregiver)

▪ SCQ

Resource utilization of health and social services was retrieved from central registers and medical records

Health and social care perspective

Improvement of caregivers’ HRQoL and the cognitive function of the PwD without increasing total costs.

Søgaard [22] Denmark, 2014

RCT

CUA

C: 3 years

H: 3 years

Community-dwelling persons with a diagnosis of AD, mixed AD diagnosis and vascular disease or dementia with Lewy bodies within the past 12 months, MMSE ≥20 and a primary caregiver willing to participate

▪ 330 randomized dyads

▪ 195 dyads in the complete case analysis

IG: Intensive, multicomponent, semi-tailored psychosocial intervention program with counselling, education and support

CG: The control group was informed about available support programs in their respective community

▪ Patient: EQ-5D proxy-rated by the caregiver

▪ Caregiver: self-rated EQ-5D

RUD and register data from national registries

Societal perspective

The psychosocial intervention is unlikely to be cost-effective since it did not generate additional QALY and it led to higher average usage of informal care.

The provision of the intervention was estimated to incur an additional average cost of €3,401. Non-statistically significant cost savings were observed for the healthcare sector and for nursing home placements, whereas higher costs were observed for informal care.

  1. AD = Alzheimer’s disease, CAU = Care as usual, CBT = Cognitive behavioral therapy, CEA = Cost-effectiveness analysis, CSDD = The Cornell Scale for Depression in Dementia, CSRI = Client Service Receipt Inventory, CUA = Cost-utility analysis, EQ-5D = EuroQoL 5-dimensions, HADS = Hospital Anxiety and Depression Scale, HRQoL = Health-related quality of life, MMSE = Mini-Mental State Examination, PwD = Person with dementia, NPI = Neuropsychiatric Inventory, QALY = Quality-Adjusted Life Year, QoL-AD = Quality of Life in Alzheimer’s Disease, RAID = Rating Anxiety in Dementia scale, QCPR = Quality of Caregiver-Patient Relationship, RAND 36 = RAND 36-Item Health Survey, RCT = Randomized controlled trial; RUD = Resource Utilization in Dementia, SCQ = The Sense of Competence Questionnaire