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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