Abstract
Many people with dementia live in the community; thus, supporting informal caregivers is critical. The Connected Health intervention facilitates collection and sharing of patient data among informal caregivers and providers to identify emerging patient needs and support rapid decision-making. This study estimates the costs of care of dementia using time-driven activity based costing of an exemplar patient. Intervention costs and health utility values were derived from a feasibility study of the intervention. A Markov model produced estimates of the cost-effectiveness of the intervention under four scenarios: (1) a minimal effect of the intervention on disease progression; (2) moderate effects on disease progression, and minimal effects on quality of life (QOL) and cost; (3) minimal effects on disease progression and QOL, and a moderate effect on cost; (4) moderate effects on disease progression and cost, with minimal effects on QOL. Cost estimates of formal and informal care ranged from €3713 to €7614 per month. Intervention costs were €484 per month. Under scenarios 2, 3 and 4, the cost per quality-adjusted life year of the intervention falls below €45,000, the threshold below which the Health Information and Quality Authority in Ireland generally accepts interventions as cost-effective. The results suggest that the intervention would be cost-effective with limited reductions in rates of disease progression and cost of care, and with minimal improvements in quality of life. Future research should consider the specific experiences of intervention patients.
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Acknowledgements
The authors would like to acknowledge James Fullam, Ph.D., Denis Curtin, MD, and Sarah Cosgrove, RGN for their contributions to this research. Dr. Fullam contributed to the cost data collection, while Dr. Curtin and Ms. Cosgrove were involved in the feasibility study of the intervention. In addition, the authors thank two anonymous reviewers for their helpful feedback and suggestions.
Funding
This study was supported by Applied Research for Connected Health. The center is funded by industry, but the current study was performed independently, meaning at no point did industry direct the research activities and that the manuscript was not subject to review by industry partners prior to publication.
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All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
Appendix: Sensitivity analysis
Appendix: Sensitivity analysis
We conducted a sensitivity analysis to assess the extent to which different rates of disease progression impact our results. We derived monthly transition probabilities from Spackman et al. (2012). The transition probabilities for standard of care, as well as for two hypothetical scenarios characterized by 1 and 2 month delays in transitions from mild and moderate states are shown below in Table 6.
Costs and health utility values are identical to those used to represent standard of care and scenarios 1 and 4 in the body of the paper. Those values are shown in Table 7.
As noted in the main body of the paper, we calculated costs, QALYs and incremental costs per QALY over a 10 year timeframe due to the slower rate of disease progression observed by Spackman et al. (2012). To ease comparisons to our main results, we also present outcomes over 4 years in Table 8.
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Dowd, W.N., Cowell, A.J., Regan, D. et al. An Exploratory Cost-Effectiveness Analysis of the Connected Health Intervention to Improve Care for People with Dementia: A Simulation Analysis. Health Serv Outcomes Res Method 18, 47–62 (2018). https://doi.org/10.1007/s10742-017-0175-y
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DOI: https://doi.org/10.1007/s10742-017-0175-y