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[null,null,"This Excel workbook contains the Evidence Map generated from the HEORO database for -\nEconomic models in Dementia. "]
[]
[]
[null,null,"How this Evidence Map was generated"]
[null,null,"We searched heoro.com on the 30th May 2017 with the following field settings:"]
[null,null,"Disease: Dementia AND Study type:  Economic model studies: cost-benefit, cost-effectiveness, cost-utility"]
[null,null,"The search identified a total of 131 abstracts published since 1960, which were  segmented with the following standard heoro.com fields:"]
[null,null,null,"Locations - these are the geographical location of the study."]
[null,null,null,"Diseases - the types of dementia assessed in the study"]
[null,null,null,"Interventions - these are the interventions examined taken from the heoro.com interventions ontology."]
[null,null,null,"Study types - whether the model was a cost-benefit, cost-effectiveness and/or cost-utility evaluation."]
[null,null,"In addition the following publication date segmentations are used:"]
[null,null,null,"1960 to 1999, 2000 to 2004, 2005 to 2009, 2010 to 2014, 2015 to 2017"]
[null,null,"All data in this Evidence Map is taken from the heoro.com database"]
[]
[null,null,"Details of the PubMed search strategy used to populate the heoro.com database can be found here."]
[]
[null,null,"Contact us:"]
[null,null,"Address: Crystallise Ltd. Unit 21, Thames Enterpise Centre, Thames Industrial Park, East Tilbury, Essex, UK RM18 8RH"]
[null,null,"Tel: +44 (0)1375 488020"]
[null,null,"Email: heoro@crystallise.com"]

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[1,"Woods RT,Orrell M,Bruce E,Edwards RT,Hoare Z,Hounsome B,Keady J,Moniz-Cook E,Orgeta V,Rees J,Russell I. REMCARE: Pragmatic Multi-Centre Randomised Trial of Reminiscence Groups for People with Dementia and their Family Carers: Effectiveness and Economic Analysis. PLoS One. 2016;11(4):e0152843. ","doi: 10.1371/journal.pone.0152843. ","Woods RT,Orrell M,Bruce E,Edwards RT,Hoare Z,Hounsome B,Keady J,Moniz-Cook E,Orgeta V,Rees J,Russell I."," REMCARE: Pragmatic Multi-Centre Randomised Trial of Reminiscence Groups for People with Dementia and their Family Carers: Effectiveness and Economic Analysis.","Joint reminiscence groups,involving people with dementia and family carers together,are popular,but the evidence-base is limited. This study aimed to assess the effectiveness and cost-effectiveness of joint reminiscence groups as compared to usual care. This multi-centre,pragmatic randomised controlled trial had two parallel arms: intervention group and usual-care control group. A restricted dynamic method of randomisation was used,with an overall allocation ratio of 1:1,restricted to ensure viable sized intervention groups. Assessments,blind to treatment allocation,were carried out at baseline,three months and ten months (primary end-point),usually in the person's home. Participants were recruited in eight centres,mainly through NHS Memory Clinics and NHS community mental health teams. Included participants were community resident people with mild to moderate dementia (DSM-IV),who had a relative or other care-giver in regular contact,to act as informant and willing and able to participate in intervention. 71% carers were spouses. 488 people with dementia (mean age 77.5)were randomised: 268 intervention,220 control; 350 dyads completed the study (206 intervention,144 control). The intervention evaluated was joint reminiscence groups (with up to 12 dyads) weekly for twelve weeks; monthly maintenance sessions for further seven months. Sessions followed a published treatment manual and were held in a variety of community settings. Two trained facilitators in each centre were supported by volunteers. Primary outcome measures were self-reported quality of life for the person with dementia (QoL-AD),psychological distress for the carer (General Health Questionnaire,GHQ-28). Secondary outcome measures included: autobiographical memory and activities of daily living for the person with dementia; carer stress for the carer; mood,relationship quality and service use and costs for both. The intention to treat analysis (ANCOVA) identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes (self-reported QoL-AD mean difference 0.07 (-1.21 to 1.35),F = 0.48,p = 0.53). Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a General Health Questionnaire-28 sub-scale at the ten month end-point (mean difference 1.25 (0.25 to 2.26),F = 8.28,p = 0.04). Compliance analyses suggested improved autobiographical memory,quality of life and relationship quality for people with dementia attending more reminiscence sessions,however carers attending more groups showed increased care-giving stress. Economic analyses from a public sector perspective indicated that joint reminiscence groups are unlikely to be cost-effective. There were no significant adverse effects attributed to the intervention. Potential limitations of the study include less than optimal attendance at the group sessions--only 57% of participants attended at least half of the intervention sessions over the 10 month period,and a higher rate of study withdrawal in the control group. This trial does not support the clinical effectiveness or cost-effectiveness of joint reminiscence groups. Possible beneficial effects for people with dementia who attend sessions as planned are offset by raised anxiety and stress in their carers. The reasons for these discrepant outcomes need to be explored further,and may necessitate reappraisal of the movement towards joint interventions. ISRCTN Registry ISRCTN42430123."," PLoS One. 2016;11(4):e0152843. ","UK",2016,"Any dementia","Other psychological therapies",null,null,null,"Unclear"]
[2,"Hindle JV,Watermeyer TJ,Roberts J,Martyr A,Lloyd-Williams H,Brand A,Gutting P,Hoare Z,Edwards RT,Clare L. Cognitive rehabiliation for Parkinson's disease demantia: a study protocol for a pilot randomised controlled trial. Trials. 2016 Mar 22;17():152. ","doi: 10.1186/s13063-016-1253-0. ","Hindle JV,Watermeyer TJ,Roberts J,Martyr A,Lloyd-Williams H,Brand A,Gutting P,Hoare Z,Edwards RT,Clare L."," Cognitive rehabiliation for Parkinson's disease demantia: a study protocol for a pilot randomised controlled trial.","There is growing interest in developing non-pharmacological treatments to address the cognitive deficits apparent in Parkinson's disease dementia and dementia with Lewy bodies. Cognitive rehabilitation is a goal-oriented behavioural intervention which focuses on improving everyday functioning through management of cognitive difficulties; it has been shown to be effective in Alzheimer's disease. To date,no studies have assessed its potential efficacy for addressing the impact of cognitive impairment in people with Parkinson's disease or dementia with Lewy bodies. Participants (n = 45) will be recruited from movement disorders,care for the elderly and memory clinics. Inclusion criteria include: a diagnosis of Parkinson's disease,Parkinson's disease dementia or dementia with Lewy bodies according to consensus criteria and an Addenbrooke's Cognitive Examination - III score of ≤ 82. Exclusion criteria include: a diagnosis of any other significant neurological condition; major psychiatric disorder,including depression,which is not related to the patient's Parkinson's disease and unstable medication use for their physical or cognitive symptoms. A single-blind pilot randomised controlled trial,with concurrent economic evaluation,will compare the relative efficacy of cognitive rehabilitation with that of two control conditions. Following a goal-setting interview,the participants will be randomised to one of the three study arms: cognitive rehabilitation (eight weekly sessions),relaxation therapy (eight weekly sessions) or treatment as usual. Randomisation and treatment group allocation will be carried out by a clinical trials unit using a dynamic adaptive sequential randomisation algorithm. The primary outcomes are patients' perceived goal attainment at a 2-months post-intervention assessment and a 6-months follow-up. Secondary outcomes include patients' objective cognitive performance (on tests of memory and executive function) and satisfaction with goal attainment,carers' perception of patients' goal attainment and patients' and carers' health status and psychosocial well-being,measured at the same time points. Cost-effectiveness will be examined to explore the design of a larger cost-effectiveness analysis alongside a full trial. This pilot study will evaluate the application of cognitive rehabilitation for the management of cognitive difficulties associated with Parkinson's disease dementia and dementia with Lewy bodies. The results of the study will inform the design of a fully powered randomised controlled trial. ISRCTN16584442 DOI 10.1186/ISRCTN16584442 13 April 2015."," Trials. 2016 Mar 22;17():152. ","UK",2016,"Lewy body dementia,Parkinson’s dementia","Cognitive therapies",null,null,null,"Unclear"]
[3,"Orgeta V,Leung P,Yates L,Kang S,Hoare Z,Henderson C,Whitaker C,Burns A,Knapp M,Leroi I,Moniz-Cook ED,Pearson S,Simpson S,Spector A,Roberts S,Russell IT,de Waal H,Woods RT,Orrell M. Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic,multicentre,randomised controlled trial. Health Technol Assess. 2015 Aug;19(64):1-108. ","doi: 10.3310/hta19640. ","Orgeta V,Leung P,Yates L,Kang S,Hoare Z,Henderson C,Whitaker C,Burns A,Knapp M,Leroi I,Moniz-Cook ED,Pearson S,Simpson S,Spector A,Roberts S,Russell IT,de Waal H,Woods RT,Orrell M."," Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic,multicentre,randomised controlled trial.","Group cognitive stimulation therapy programmes can benefit cognition and quality of life for people with dementia. Evidence for home-based,carer-led cognitive stimulation interventions is limited. To evaluate the clinical effectiveness and cost-effectiveness of carer-delivered individual cognitive stimulation therapy (iCST) for people with dementia and their family carers,compared with treatment as usual (TAU). A multicentre,single-blind,randomised controlled trial assessing clinical effectiveness and cost-effectiveness. Assessments were at baseline,13 weeks and 26 weeks (primary end point). Participants were recruited through Memory Clinics and Community Mental Health Teams for older people. A total of 356 caregiving dyads were recruited and 273 completed the trial. iCST consisted of structured cognitive stimulation sessions for people with dementia,completed up to three times weekly over 25 weeks. Family carers were supported to deliver the sessions at home. Primary outcomes for the person with dementia were cognition and quality of life. Secondary outcomes included behavioural and psychological symptoms,activities of daily living,depressive symptoms and relationship quality. The primary outcome for the family carers was mental/physical health (Short Form questionnaire-12 items). Health-related quality of life (European Quality of Life-5 Dimensions),mood symptoms,resilience and relationship quality comprised the secondary outcomes. Costs were estimated from health and social care and societal perspectives. There were no differences in any of the primary outcomes for people with dementia between intervention and TAU [cognition: mean difference -0.55,95% confidence interval (CI) -2.00 to 0.90; p-value = 0.45; self-reported quality of life: mean difference -0.02,95% CI -1.22 to 0.82; p-value = 0.97 at the 6-month follow-up]. iCST did not improve mental/physical health for carers. People with dementia in the iCST group experienced better relationship quality with their carer,but there was no evidence that iCST improved their activities of daily living,depression or behavioural and psychological symptoms. iCST seemed to improve health-related quality of life for carers but did not benefit carers' resilience or their relationship quality with their relative. Carers conducting more sessions had fewer depressive symptoms. Qualitative data suggested that people with dementia and their carers experienced better communication owing to iCST. Adjusted mean costs were not significantly different between the groups. From the societal perspective,both health gains and cost savings were observed. iCST did not improve cognition or quality of life for people with dementia,or carers' physical and mental health. Costs of the intervention were offset by some reductions in social care and other services. Although there was some evidence of improvement in terms of the caregiving relationship and carers' health-related quality of life,iCST does not appear to deliver clinical benefits for cognition and quality of life for people with dementia. Most people received fewer than the recommended number of iCST sessions. Further research is needed to ascertain the clinical effectiveness of carer-led cognitive stimulation interventions for people with dementia. Current Controlled Trials ISRCTN65945963. "," Health Technol Assess. 2015 Aug;19(64):1-108. ","UK",2015,"Any dementia","Cognitive therapies",null,null,null,"Cost-utility"]
[4,"Mirsaeedi-Farahani K,Halpern CH,Baltuch GH,Wolk DA,Stein SC. Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis. J Neurol. 2015 May;262(5):1191-7. ","doi: 10.1007/s00415-015-7688-5. ","Mirsaeedi-Farahani K,Halpern CH,Baltuch GH,Wolk DA,Stein SC."," Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis.","Alzheimer disease (AD) is characterized by impairments in memory function. Standard AD treatment provides marginal improvements in this domain. Recent reports,however,suggested that deep brain stimulation (DBS) may result in improved memory. Given significant equipment costs and health expenses required for DBS surgery,we determine clinical and economic thresholds required for it to be as effective as standard AD treatment. Literature review yielded annual AD progression probabilities,health-related quality of life (QoL),and costs by AD stage. Our 5-year decision analysis model compared cumulative QoL in quality-adjusted life years (QALYs) and costs of standard therapy to theoretical DBS treatment of various success rates,using known complication rates and QoL data. The base case was a patient with mild-stage AD. DBS success was defined as regression to and maintenance of minimal stage AD,which was defined as midway between mild and no dementia,for the first year,and continuation of the natural course of AD for the remaining 4 years. Compared to standard treatment alone,DBS for mild-stage AD requires a success rate of 3% to overcome effects of possible surgical complications on QoL. If DBS can be delivered with success rates above 20% ($200 K/QALY) or 74% ($50 K/QALY) for mild AD,it can be considered cost-effective. Above a success rate of 80%,DBS treatment is both clinically more effective and more cost-effective than standard treatment. Our findings demonstrate that clinical and economic thresholds required for DBS to be cost-effective for AD are relatively low."," J Neurol. 2015 May;262(5):1191-7. ","USA",2015,"Alzheimer’s","Deep brain stimulation",null,null,null,"Cost-utility"]
[5,"D'Amico F,Rehill A,Knapp M,Aguirre E,Donovan H,Hoare Z,Hoe J,Russell I,Spector A,Streater A,Whitaker C,Woods RT,Orrell M. Maintenance cognitive stimulation therapy: an economic evaluation within a randomized controlled trial. J Am Med Dir Assoc. 2015 Jan;16(1):63-70. ","doi: 10.1016/j.jamda.2014.10.020. ","D'Amico F,Rehill A,Knapp M,Aguirre E,Donovan H,Hoare Z,Hoe J,Russell I,Spector A,Streater A,Whitaker C,Woods RT,Orrell M."," Maintenance cognitive stimulation therapy: an economic evaluation within a randomized controlled trial.","Cognitive Stimulation Therapy (CST) is effective and cost-effective for people with mild-to-moderate dementia when delivered biweekly over 7 weeks. To examine whether longer-term (maintenance) CST is cost-effective when added to usual care. Cost-effectiveness analysis within multicenter,single-blind,pragmatic randomized controlled trial; subgroup analysis for people taking acetylcholinesterase inhibitors (ACHEIs). A total of 236 participants with mild-to-moderate dementia received CST for 7 weeks. They were randomized to either weekly maintenance CST added to usual care or usual care alone for 24 weeks. Although outcome gains were modest over 6 months,maintenance CST appeared cost-effective when looking at self-rated quality of life as primary outcome,and cognition (MMSE) and proxy-rated quality-adjusted life years as secondary outcomes. CST in combination with ACHEIs offered cost-effectiveness gains when outcome was measured as cognition. Continuation of CST is likely to be cost-effective for people with mild-to-moderate dementia."," J Am Med Dir Assoc. 2015 Jan;16(1):63-70. ","UK",2015,"Any dementia","Cognitive therapies",null,null,null,"Cost-utility"]
[6,"Livingston G,Barber J,Rapaport P,Knapp M,Griffin M,Romeo R,King D,Livingston D,Lewis-Holmes E,Mummery C,Walker Z,Hoe J,Cooper C. START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia. Health Technol Assess. 2014 Oct;18(61):1-242. ","doi: 10.3310/hta18610.","Livingston G,Barber J,Rapaport P,Knapp M,Griffin M,Romeo R,King D,Livingston D,Lewis-Holmes E,Mummery C,Walker Z,Hoe J,Cooper C."," START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia.","Two-thirds of people with dementia live at home,receiving most care from family carers,about 40% of whom have clinically significant depression or anxiety. This impacts on the person with dementia,families and society,predicting care breakdown. There are currently no clinically effective and cost-effective NHS family carer interventions. To assess the STrAtegies for RelaTives (START) intervention in the short (4 and 8 months) and long term (1 and 2 years) compared with treatment as usual (TAU). Randomised,parallel-group,superiority trial with blinded assessment recruiting participants 2:1 (intervention to TAU) to allow for therapist clustering. Three UK mental health services and one neurological service. Family carers of people with dementia. Eight-session manual-based coping intervention delivered by supervised psychology graduates to individuals. Affective symptoms [Hospital Anxiety and Depression Scale-total (HADS-T)] and cost-effectiveness. Secondary measures: anxiety and depression symptoms and caseness,quality of life (QoL),abusive behaviour and long-term care home admission. Two hundred and sixty participants were randomised (173 intervention,87 TAU). We used intention-to-treat analysis in the short term (152 intervention,77 TAU) and in the long term (140 intervention,69 TAU). In the short term,the intervention group had lower HADS-T [mean difference -1.80,95% confidence interval (CI) -3.29 to -0.31; p=0.02] and higher quality-adjusted life-years (QALYs) (mean difference 0.03,95% CI -0.01 to 0.08). Costs were no different between groups [mean £ 252 (95% CI -£ 28 to £ 565) for intervention group]. The cost-effectiveness acceptability curve showed a greater than 99% chance of being cost-effectiveness at a £ 30,000/QALY willingness-to-pay threshold and a high probability of cost-effectiveness based on the HADS-T score. Carers in the intervention group had less case-level depression [odds ratio (OR) 0.24,95% CI 0.07 to 0.76],a trend towards reduced case-level anxiety (OR 0.30,95% CI 0.08 to 1.05),lower Hospital Anxiety and Depression Scale-anxiety (HADS-A) (-0.91,95% CI -1.76 to -0.07; p = 0.03) and Hospital Anxiety and Depression Scale-depression (HADS-D) (-0.91,95% CI -1.71 to -0.10; p = 0.03) and higher Health Status Questionnaire (HSQ) QoL (mean difference 4.09,95% CI 0.34 to 7.83). Group differences in abusive behaviour (OR 0.48,95% CI 0.18 to 1.27) and the person with dementia's quality of life-Alzheimer's disease (QoL-AD) (mean increase 0.59,95% CI -0.72 to 1.89) were not significant. In the long term,the intervention group had lower HADS-T (mean difference -2.58,95% CI -4.26 to -0.90; p = 0.03) and higher QALYs (mean difference 0.03,95% CI -0.01 to 0.06). Carers in the intervention group had less case-level depression (OR 0.14,95% CI 0.04 to 0.53),a trend towards reduced case-level anxiety (OR 0.57,95% CI 0.26 to 1.24),lower HADS-A (-1.16,95% CI -2.15 to -0.18) and HADS-D (1.45,95% CI -2.32 to -0.57),and higher HSQ (mean difference 7.47,95% CI 2.87 to 12.08). Thirty-two (18.7%) people with dementia in the intervention group and 17 (20.2%) in TAU were admitted to a care home (hazard ratio 0.83,95% CI 0.44 to 1.56; p = 0.56). There were no significant differences between groups in abusive behaviour (OR 0.83,95% CI 0.36 to 1.94),the person with dementia's QoL-AD (0.17,95% CI -1.37 to 1.70) or costs (£ 336,95% CI -£ 223 to £ 895) for intervention group. The probability that the intervention would be seen as cost-effective at £ 30,000/QALY threshold and cost-effectiveness on the HADS-T remained high. The START intervention was clinically effective and cost-effective in the short and longer term. The results are robust to the sensitivity analyses performed. Future work is needed to consider mechanism of action; the effects on people with dementia in clinical terms (cognition,neuropsychiatric symptoms,longer-term care home admission); and on health and social care costs. In addition,we will explore the effects of carer abusive behaviour on the care recipient's care home admission and if this then reduces abusive behaviour. We would also like to implement START and evaluate this implementation in clinical practice. Current Controlled Trials ISCTRN70017938."," Health Technol Assess. 2014 Oct;18(61):1-242. ","UK",2014,"Any dementia","Support",null,null,null,"Cost-utility"]
[7,"Wouters H,Quik EH,Boersma F,Nygård P,Bosman J,Böttger WM,Mulder H,Maring JG,Wijma-Vos L,Beerden T,van Doormaal J,Postma MJ,Zuidema SU,Taxis K. Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial. BMJ Open. 2014 Oct 8;4(10):e006082. ","doi: 10.1136/bmjopen-2014-006082.","Wouters H,Quik EH,Boersma F,Nygård P,Bosman J,Böttger WM,Mulder H,Maring JG,Wijma-Vos L,Beerden T,van Doormaal J,Postma MJ,Zuidema SU,Taxis K."," Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial.","Nursing home residents often have a high number of comorbidities resulting in polypharmacy. Inappropriate prescribing is therefore likely to occur,which in turn is expected to worsen cognitive impairment,to increase the fall risk and to decrease residents' quality of life. The objective of the 'Discontinuing Inappropriate Medication in Nursing Home Residents' (DIM-NHR) study is to examine the efficacy and cost-effectiveness of the Multidisciplinary Multistep Medication Review (3MR) that is aimed at optimising prescribing and discontinuing inappropriate medication. A cluster randomised controlled trial will be conducted. Elderly care physicians and their wards (clusters) will be randomised. Data will be collected at baseline and 4 months after the 3MR has taken place. Six hundred nursing home residents will be recruited of whom more than half are expected to suffer from dementia. The 3MR will be based on consensus criteria and the relevant literature and will be performed by the patient's elderly care physician in collaboration with a pharmacist. Primary outcomes-the difference in proportion of residents who successfully discontinued inappropriate medication between the intervention and control group at follow-up. Secondary outcomes-undertreatment,exposure to anticholinergic and sedative medicines,neuropsychiatric symptoms,cognitive function,falls,hospital admission,quality of life and cost-effectiveness. Participant burden will be kept at a minimum. The elderly care physician will remain free to adjust medication when symptoms relapse or adverse events occur,rendering serious adverse events highly unlikely. Study findings will be published in peer-reviewed journals and a 3MR toolkit will be developed. This study has been registered at http://www.ClinicalTrials.gov (trial registration number: NCT01876095)."," BMJ Open. 2014 Oct 8;4(10):e006082. ","Netherlands",2014,"Any dementia","Disease management",null,null,null,"Unclear"]
[8,"Versijpt J. Effectiveness and cost-effectiveness of the pharmacological treatment of Alzheimer's disease and vascular dementia. J Alzheimers Dis. 2014;42 Suppl 3():S19-25. ","doi: 10.3233/JAD-132639. ","Versijpt J."," Effectiveness and cost-effectiveness of the pharmacological treatment of Alzheimer's disease and vascular dementia.","Until an effective and especially disease-modifying treatment for Alzheimer's disease (AD) and vascular dementia (VaD) is available,the currently available pharmacological therapeutic arsenal aims at merely improving symptomatology. Health economic data make an important contribution to the planning of healthcare services and the estimation of the cost of drug reimbursement. As such,both for cholinesterase inhibitors and,to a lesser extent,for memantine it can be claimed that the direct cost of the drug itself is eclipsed by the cost savings associated with delaying institutionalization or delaying the time of progression into a more severe disease state. The present manuscript reviews several factors contributing to the costs of dementia,gives an overview of available studies claiming both the effectiveness and cost-effectiveness of current dementia treatments,and highlights strengths and weaknesses of the aforementioned studies."," J Alzheimers Dis. 2014;42 Suppl 3():S19-25. ","International",2014,"Alzheimer’s,Vascular dementia","Any anticholinesterase",null,null,null,"Unclear"]
[9,"Livingston G,Kelly L,Lewis-Holmes E,Baio G,Morris S,Patel N,Omar RZ,Katona C,Cooper C. A systematic review of the clinical effectiveness and cost-effectiveness of sensory,psychological and behavioural interventions for managing agitation in older adults with dementia. Health Technol Assess. 2014 Jun;18(39):1-226,v-vi. ","doi: 10.3310/hta18390. ","Livingston G,Kelly L,Lewis-Holmes E,Baio G,Morris S,Patel N,Omar RZ,Katona C,Cooper C."," A systematic review of the clinical effectiveness and cost-effectiveness of sensory,psychological and behavioural interventions for managing agitation in older adults with dementia.","Agitation is common,persistent and distressing in dementia and is linked with care breakdown. Psychotropic medication is often ineffective or harmful,but the evidence regarding non-pharmacological interventions is unclear. We systematically reviewed and synthesised the evidence for clinical effectiveness and cost-effectiveness of non-pharmacological interventions for reducing agitation in dementia,considering dementia severity,the setting,the person with whom the intervention is implemented,whether the effects are immediate or longer term,and cost-effectiveness. We searched twice using relevant search terms (9 August 2011 and 12 June 2012) in Web of Knowledge (incorporating MEDLINE); EMBASE; British Nursing Index; the Health Technology Assessment programme database; PsycINFO; NHS Evidence; System for Information on Grey Literature; The Stationery Office Official Documents website; The Stationery National Technical Information Service; Cumulative Index to Nursing and Allied Health Literature; and The Cochrane Library. We also searched Cochrane reviews of interventions for behaviour in dementia,included papers' references,and contacted authors about 'missed' studies. We included quantitative studies,evaluating non-pharmacological interventions for agitation in dementia,in all settings. We rated quality,prioritising higher-quality studies. We separated results by intervention type and agitation level. As we were unable to meta-analyse results except for light therapy,we present a qualitative evidence synthesis. In addition,we calculated standardised effect sizes (SESs) with available data,to compare heterogeneous interventions. In the health economic analysis,we reviewed economic studies,calculated the cost of effective interventions from the effectiveness review,calculated the incremental cost per unit improvement in agitation,used data from a cohort study to evaluate the relationship between health and social care costs and health-related quality of life (DEMQOL-Proxy-U scores) and developed a new cost-effectiveness model. We included 160 out of 1916 papers screened. Supervised person-centred care,communication skills (SES = -1.8 to -0.3) or modified dementia care mapping (DCM) with implementing plans (SES = -1.4 to -0.6) were all efficacious at reducing clinically significant agitation in care home residents,both immediately and up to 6 months afterwards. In care home residents,during interventions but not at follow-up,activities (SES = -0.8 to -0.6) and music therapy (SES = -0.8 to -0.5) by protocol reduced mean levels of agitation; sensory intervention (SES = -1.3 to -0.6) reduced mean and clinically significant symptoms. Advantages were not demonstrated with 'therapeutic touch' or individualised activity. Aromatherapy and light therapy did not show clinical effectiveness. Training family carers in behavioural or cognitive interventions did not decrease severe agitation. The few studies reporting activities of daily living or quality-of-life outcomes found no improvement,even when agitation had improved. We identified two health economic studies. Costs of interventions which significantly impacted on agitation were activities,£80-696; music therapy,£13-27; sensory interventions,£3-527; and training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM,£31-339. Among the 11 interventions that were evaluated using the Cohen-Mansfield Agitation Inventory (CMAI),the incremental cost per unit reduction in CMAI score ranged from £162 to £3480 for activities,£4 for music therapy,£24 to £143 for sensory interventions,and £6 to £62 for training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM. Health and social care costs ranged from around £7000 over 3 months in people without clinically significant agitation symptoms to around £15,000 at the most severe agitation levels. There is some evidence that DEMQOL-Proxy-U scores decline with Neuropsychiatric Inventory agitation scores. A multicomponent intervention in participants with mild to moderate dementia had a positive monetary net benefit and a 82.2% probability of being cost-effective at a maximum willingness to pay for a quality-adjusted life-year of £20,000 and a 83.18% probability at a value of £30,000. Although there were some high-quality studies,there were only 33 reasonably sized (> 45 participants) randomised controlled trials,and lack of evidence means that we cannot comment on many interventions' effectiveness. There were no hospital studies and few studies in people's homes. More health economic data are needed. Person-centred care,communication skills and DCM (all with supervision),sensory therapy activities,and structured music therapies reduce agitation in care-home dementia residents. Future interventions should change care home culture through staff training and permanently implement evidence-based treatments and evaluate health economics. There is a need for further work on interventions for agitation in people with dementia living in their own homes. The study was registered as PROSPERO no. CRD42011001370."," Health Technol Assess. 2014 Jun;18(39):1-226,v-vi. ","UK",2014,"Any dementia","Behavioural therapies,Cognitive therapies,Other psychological therapies",null,null,null,"Cost-utility"]
[10,"Fowler NR,Harrawood A,Frame A,Perkins AJ,Gao S,Callahan CM,Sachs GA,French DD,Boustani MA. The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of dementia screening (CHOICE) study: study protocol for a randomized controlled trial. Trials. 2014 Jun 6;15():209. ","doi: 10.1186/1745-6215-15-209.","Fowler NR,Harrawood A,Frame A,Perkins AJ,Gao S,Callahan CM,Sachs GA,French DD,Boustani MA."," The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of dementia screening (CHOICE) study: study protocol for a randomized controlled trial.","Dementia affects over 4 million people in the US and is frequently unrecognized and underdiagnosed in primary care. Routine dementia screening in primary care is not recommended by the US Preventive Services Task Force due to lack of empirical data on the benefits and harms of screening. This trial seeks to fill this gap and contribute information about the benefits,harms,and costs of routine screening for dementia in primary care. Single-blinded,parallel,randomized controlled clinical trial with 1:1 allocation. A total of 4,000 individuals aged ≥65 years without a diagnosis of dementia,cognitive impairment,or serious mental illness receiving care at primary care practices within two cities in Indiana. Subjects will be randomized to either i) screening for dementia using the Memory Impairment Screen Telephone version or ii) no screening for dementia. Subjects who screen positive for dementia will be referred to the local Aging Brain Care program that delivers an evidence-based collaborative care model for dementia and depression. Research assistants will administer the 15-item Health Utility Index,Patient Health Questionnaire,Generalized Anxiety Disorder Scale,and Medical Outcomes Study at baseline,1,6,and 12 months. Information about advanced care planning will be collected at baseline and 12 months. All enrollees' medical records will be reviewed to collect data on health care utilization and costs. We have two primary hypotheses; first,in comparison to non-screened subjects,those who are screened and referred to a dementia collaborative care program will have a higher health-related quality of life as measured by the Health Utility Index at 12 months post-screening. Second,in comparison to non-screened subjects,those who are screened and referred to a dementia collaborative care program will not have higher depression or anxiety at one month post-screening as measured by the Patient Health Questionnaire and Generalized Anxiety Disorder Scale scales. Our secondary hypothesis is that screened subjects will have an Incremental Cost-Effectiveness Ratio below the maximum acceptable threshold of $60,000 per quality adjusted life year saved at 12 months. Ongoing; registered on September 19,2012. ClinicalTrials.gov Identifier: 2012 NCT01699503."," Trials. 2014 Jun 6;15():209. ","USA",2014,"Any dementia","Diagnosis",null,null,null,"Cost-utility"]
[11,"Quinn C,Anderson D,Toms G,Whitaker R,Edwards RT,Jones C,Clare L. Self-management in early-stage dementia: a pilot randomised controlled trial of the efficacy and cost-effectiveness of a self-management group intervention (the SMART study). Trials. 2014 Mar 8;15():74. ","doi: 10.1186/1745-6215-15-74. ","Quinn C,Anderson D,Toms G,Whitaker R,Edwards RT,Jones C,Clare L."," Self-management in early-stage dementia: a pilot randomised controlled trial of the efficacy and cost-effectiveness of a self-management group intervention (the SMART study).","The possibility of living well with a long-term condition has been identified as centrally relevant to the needs of people living with dementia. Growing numbers of people with early-stage dementia are contributing accounts that emphasise the benefits of actively engaging in managing the condition. Self-management interventions share the common objectives of educating about the condition,optimising well-being,enhancing control over the situation and enabling people to take more responsibility for managing the condition. Benefits of such an approach can include improved knowledge,self-efficacy,health status,and better performance of self-management behaviours. However,there is only preliminary evidence that people with early-stage dementia can benefit from such interventions. This feasibility study involves the development of a self-management group intervention for people with early-stage Alzheimer's disease,vascular dementia or mixed Alzheimer's and vascular dementia. This study is a single-site pilot randomised-controlled trial. Forty-two people with early stage dementia,each with a caregiver (family member/friend),will be randomised to either the self-management group intervention or to treatment as usual.The self-management group intervention will involve eight weekly sessions,each lasting 90 minutes,held at a memory clinic in North Wales. All participants will be re-assessed three and six months post-randomisation. This study is intended to supply an early evaluation of the self-management intervention so that a full scale trial may be powered from the best available evidence. It will assess the feasibility of the intervention,the study design and the recruitment strategies. It will estimate the parameters and confidence intervals for the research questions of interest. The primary outcome of interest is the self-efficacy score of the person with dementia at three months post-randomisation. Secondary outcomes for the person with dementia are self-efficacy at six months post-randomisation and cognitive ability,mood and well-being at three and six months post-randomisation. Secondary outcomes for caregivers are their distress and stress at three and six months post-randomisation. The cost-effectiveness of the intervention will also be examined. This study will provide preliminary information about the feasibility,efficacy and cost-effectiveness of a self-management group intervention for people in the early stages of dementia. Current Controlled Trials,ISRCTN02023181."," Trials. 2014 Mar 8;15():74. ","UK",2014,"Alzheimer’s,Vascular dementia","Behavioural therapies",null,null,null,"Unclear"]
[12,"Bermingham SL. The appropriate use of neuroimaging in the diagnostic work-up of dementia: an economic literature review and cost-effectiveness analysis. Ont Health Technol Assess Ser. 2014;14(2):1-67. ","","Bermingham SL."," The appropriate use of neuroimaging in the diagnostic work-up of dementia: an economic literature review and cost-effectiveness analysis.","Structural brain imaging is often performed to establish the underlying causes of dementia. However,recommendations differ as to who should receive neuroimaging and whether computed tomography (CT) or magnetic resonance imaging (MRI) should be used. This study aimed to determine the cost-effectiveness in Ontario of offering structural imaging to all patients with mild to moderate dementia compared with offering it selectively according to guidelines from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCC). We compared the cost-effectiveness of CT and MRI as first-line strategies. We performed a systematic literature search (2000 to 2013) to identify cost-effectiveness studies of clinical prediction rules and structural imaging modalities. Studies were assessed for quality and applicability to Ontario. We also developed a model to evaluate the cost-effectiveness of clinical guidelines (image all versus according to CCC) and modalities (CT versus MRI). Transition probabilities,utilities,and costs were obtained from published literature or expert opinion. Results were expressed in terms of costs and quality adjusted life years (QALYs). No relevant cost-effectiveness analyses were identified in the published literature. According to the base-case results of our model,the most effective and cost-effective strategy is to image patients who meet CCC criteria with CT and to follow-up with MRI for suspected cases of space-occupying lesions (SOL). However,the results were sensitive to the specificity of MRI for detecting vascular causes of dementia. At a specificity of 64%,the most cost-effective strategy is CCC followed by MRI. Studies used to estimate diagnostic accuracy were limited by a lack of a gold standard test for establishing the cause of dementia. The model does not include costs to patients and their families,nor does it account for patient preferences about diagnostic information. Given the relative prevalence of vascular dementia and SOLs,and the improvement in QALYs associated with treatment,the strategy with the greatest combined sensitivity (CCC with CT followed by MRI for patients with SOLs) results in the greatest number of QALYs and is the least costly. Due to limitations in the clinical data and challenges in the interpretation of this evidence,the model should be considered a framework for assessing uncertainty in the evidence base rather than providing definitive answers to the research questions."," Ont Health Technol Assess Ser. 2014;14(2):1-67. ","International",2014,"Any dementia","Diagnosis",null,null,null,"Cost-utility"]
[13,"Sonntag M,König HH,Konnopka A. The estimation of utility weights in cost-utility analysis for mental disorders: a systematic review. Pharmacoeconomics. 2013 Dec;31(12):1131-54. ","doi: 10.1007/s40273-013-0107-9.","Sonntag M,König HH,Konnopka A."," The estimation of utility weights in cost-utility analysis for mental disorders: a systematic review.","To systematically review approaches and instruments used to derive utility weights in cost-utility analyses (CUAs) within the field of mental disorders and to identify factors that may have influenced the choice of the approach. We searched the databases DARE (Database of Abstracts of Reviews of Effects),NHS EED (National Health Service Economic Evaluation Database),HTA (Health Technology Assessment),and PubMed for CUAs. Studies were included if they were full economic evaluations and reported quality-adjusted life-years as the health outcome. Study characteristics and instruments used to estimate utility weights were described and a logistic regression analysis was conducted to identify factors associated with the choice of either the direct (e.g. standard gamble) or the preference-based measure (PBM) approach (e.g. EQ-5D). We identified 227 CUAs with a maximum in 2009,2010,and 2012. Most CUAs were conducted in depression,dementia,or psychosis,and came from the US or the UK,with the EQ-5D being the most frequently used instrument. The application of the direct approach was significantly associated with depression,psychosis,and model-based studies. The PBM approach was more likely to be used in recent studies,dementia,Europe,and empirical studies. Utility weights used in model-based studies were derived from only a small number of studies. We only searched four databases and did not evaluate the quality of the included studies. Direct instruments and PBMs are used to elicit utility weights in CUAs with different frequencies regarding study type,mental disorder,and country."," Pharmacoeconomics. 2013 Dec;31(12):1131-54. ","International",2013,"Any dementia","None or unclear",null,null,null,"Cost-utility"]
[14,"Meeuwsen E,Melis R,van der Aa G,Golüke-Willemse G,de Leest B,van Raak F,Schölzel-Dorenbos C,Verheijen D,Verhey F,Visser M,Wolfs C,Adang E,Olde Rikkert M. Cost-effectiveness of one year dementia follow-up care by memory clinics or general practitioners: economic evaluation of a randomised controlled trial. PLoS One. 2013;8(11):e79797. ","doi: 10.1371/journal.pone.0079797.","Meeuwsen E,Melis R,van der Aa G,Golüke-Willemse G,de Leest B,van Raak F,Schölzel-Dorenbos C,Verheijen D,Verhey F,Visser M,Wolfs C,Adang E,Olde Rikkert M."," Cost-effectiveness of one year dementia follow-up care by memory clinics or general practitioners: economic evaluation of a randomised controlled trial.","To evaluate the cost-effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared to general practitioners' care. A multicentre randomised trial with 175 community dwelling patients newly diagnosed with mild to moderate dementia,and their informal caregivers,with twelve months' follow-up. Cost-effectiveness was evaluated from a societal point of view and presented as incremental cost per quality adjusted life year. To establish cost-effectiveness,a cost-utility analysis was conducted using utilities based on the EQ-5D. Uncertainty surrounding the incremental cost-effectiveness ratio (difference in costs divided by difference in effects) was calculated by bootstrapping from the original data. Compared to general practitioners' care,treatment by the memory clinics was on average €1024 (95% CI: -€7723 to €5674) cheaper,and showed a non-significant decrease of 0.025 (95% CI: -0.114 to 0.064) quality adjusted life years. The incremental cost-effectiveness point estimate from the bootstrap simulation was € 41 442 per QALY lost if one would use memory clinic care instead of general practitioner care. No evidence was found that memory clinics were more cost-effective compared to general practitioners with regard to post-diagnosis treatment and coordination of care of patients with dementia in the first year after diagnosis. ClinicalTrials.gov NCT00554047."," PLoS One. 2013;8(11):e79797. ","Netherlands",2013,"Any dementia","Memory clinic",null,null,null,"Cost-effectiveness,Cost-utility"]
[15,"Saulle R,Semyonov L,La Torre G. Cost and cost-effectiveness of the Mediterranean diet: results of a systematic review. Nutrients. 2013 Nov 18;5(11):4566-86. ","doi: 10.3390/nu5114566.","Saulle R,Semyonov L,La Torre G."," Cost and cost-effectiveness of the Mediterranean diet: results of a systematic review.","The growing impact of chronic degenerative pathologies (such as cardiovascular disease,type 2 diabetes and Alzheimer's disease) requires and pushes towards the development of new preventive strategies to reduce the incidence and prevalence of these diseases. Lifestyle changes,especially related to the Mediterranean diet,have the potential to modify disease outcomes and ultimately costs related to their management. The objective of the study was to perform a systematic review of the scientific literature,to gauge the economic performance and the cost-effectiveness of the adherence to the Mediterranean diet as a prevention strategy against degenerative pathologies. We investigated the monetary costs of adopting Mediterranean dietary patterns by determining cost differences between low and high adherence. Research was conducted using the PubMed and Scopus databases. Eight articles met the pre-determined inclusion criteria and were reviewed. Quality assessment and data extraction was performed. The adherence to the Mediterranean diet has been extensively reported to be associated with a favorable health outcome and a better quality of life. The implementation of a Mediterranean dietary pattern may lead to the prevention of degenerative pathologies and to an improvement in life expectancy,a net gain in health and a reduction in total lifetime costs."," Nutrients. 2013 Nov 18;5(11):4566-86. ","International",2013,"Any dementia","Diet",null,null,null,"Unclear"]
[16,"Knapp M,King D,Romeo R,Schehl B,Barber J,Griffin M,Rapaport P,Livingston D,Mummery C,Walker Z,Hoe J,Sampson EL,Cooper C,Livingston G. Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial. BMJ. 2013 Oct 25;347():f6342.","","Knapp M,King D,Romeo R,Schehl B,Barber J,Griffin M,Rapaport P,Livingston D,Mummery C,Walker Z,Hoe J,Sampson EL,Cooper C,Livingston G."," Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial.","To assess whether the START (STrAtegies for RelatTives) intervention added to treatment as usual is cost effective compared with usual treatment alone. Cost effectiveness analysis nested within a pragmatic randomised controlled trial. Three mental health and one neurological outpatient dementia service in London and Essex,UK. Family carers of people with dementia. Eight session,manual based,coping intervention delivered by supervised psychology graduates to family carers of people with dementia added to usual treatment,compared with usual treatment alone. Costs measured from a health and social care perspective were analysed alongside the Hospital Anxiety and Depression Scale total score (HADS-T) of affective symptoms and quality adjusted life years (QALYs) in cost effectiveness analyses over eight months from baseline. Of the 260 participants recruited to the study,173 were randomised to the START intervention,and 87 to usual treatment alone. Mean HADS-T scores were lower in the intervention group than the usual treatment group over the 8 month evaluation period (mean difference -1.79 (95% CI -3.32 to -0.33)),indicating better outcomes associated with the START intervention. There was a small improvement in health related quality of life as measured by QALYs (0.03 (-0.01 to 0.08)). Costs were no different between the intervention and usual treatment groups (£252 (-28 to 565) higher for START group). The cost effectiveness calculations suggested that START had a greater than 99% chance of being cost effective compared with usual treatment alone at a willingness to pay threshold of £30,000 per QALY gained,and a high probability of cost effectiveness on the HADS-T measure. The manual based coping intervention START,when added to treatment as usual,was cost effective compared with treatment as usual alone by reference to both outcome measures (affective symptoms for family carers,and carer based QALYs). ISCTRN 70017938."," BMJ. 2013 Oct 25;347():f6342.","UK",2013,"Any dementia","Support",null,null,null,"Cost-utility"]
[17,"Dahlrup B,Nordell E,Steen Carlsson K,Elmståhl S. Health economic analysis on a psychosocial intervention for family caregivers of persons with dementia. Dement Geriatr Cogn Disord. 2014;37(3-4):181-95. ","doi: 10.1159/000355365.","Dahlrup B,Nordell E,Steen Carlsson K,Elmståhl S."," Health economic analysis on a psychosocial intervention for family caregivers of persons with dementia.","Psychosocial intervention has shown positive effects on the caregivers' burden and satisfaction. The aims of this study were to describe the cost and cost-effectiveness of such an intervention. We analyzed resource use and costs of formal care for 308 persons with dementia and their caregivers' health-related quality of life (HRQoL). The costs of home help services were lower in the subgroup of spouse caregivers in the intervention group and the cost of nursing home placement was lower in the intervention group. While the person with dementia lived at home,caregivers in the intervention group reported a higher HRQoL (p < 0.01). After the person with dementia had moved to a nursing home,spouses in the control group had a lower HRQoL (p < 0.001). The result can be interpreted as a positive effect of the intervention focusing on the identified specific needs of the family caregivers."," Dement Geriatr Cogn Disord. 2014;37(3-4):181-95. ","Sweden",2014,"Any dementia","Other psychological therapies",null,null,null,"Cost-utility"]
[18,"Goldfeld KS. Twice-weighted multiple interval estimation of a marginal structural model to analyze cost-effectiveness. Stat Med. 2014 Mar 30;33(7):1222-41. ","doi: 10.1002/sim.6017. ","Goldfeld KS."," Twice-weighted multiple interval estimation of a marginal structural model to analyze cost-effectiveness.","Cost-effectiveness analysis is an important tool that can be applied to the evaluation of a health treatment or policy. When the observed costs and outcomes result from a nonrandomized treatment,making causal inference about the effects of the treatment requires special care. The challenges are compounded when the observation period is truncated for some of the study subjects. This paper presents a method of unbiased estimation of cost-effectiveness using observational study data that is not fully observed. The method-twice-weighted multiple interval estimation of a marginal structural model-was developed in order to analyze the cost-effectiveness of treatment protocols for advanced dementia residents living nursing homes when they become acutely ill. A key feature of this estimation approach is that it facilitates a sensitivity analysis that identifies the potential effects of unmeasured confounding on the conclusions concerning cost-effectiveness."," Stat Med. 2014 Mar 30;33(7):1222-41. ","Unknown",2014,"Any dementia","Disease management",null,null,null,"Unclear"]
[19,"Joling KJ,Bosmans JE,van Marwijk HW,van der Horst HE,Scheltens P,Vroomen JL,van Hout HP. The cost-effectiveness of a family meetings intervention to prevent depression and anxiety in family caregivers of patients with dementia: a randomized trial. Trials. 2013 Sep 22;14():305. ","doi: 10.1186/1745-6215-14-305.","Joling KJ,Bosmans JE,van Marwijk HW,van der Horst HE,Scheltens P,Vroomen JL,van Hout HP."," The cost-effectiveness of a family meetings intervention to prevent depression and anxiety in family caregivers of patients with dementia: a randomized trial.","Dementia imposes a heavy burden on health and social care systems as well as on family caregivers who provide a substantial portion of the care. Interventions that effectively support caregivers may prevent or delay patient institutionalization and hence be cost-effective. However,evidence about the cost-effectiveness of such interventions is scarce. The aim of this study was to evaluate the cost-effectiveness of a family meetings intervention for family caregivers of dementia patients in comparison with usual care over a period of 12 months. The economic evaluation was conducted from a societal perspective alongside a randomized trial of 192 primary caregivers with community-dwelling dementia patients. Outcome measures included the Quality Adjusted Life-Years (QALY) of caregivers and patients and the incidence of depression and anxiety disorders in caregivers. Missing cost and effect data were imputed using multiple imputations. Bootstrapping was used to estimate uncertainty around the cost-differences and the incremental cost-effectiveness ratio (ICER). The bootstrapped cost-effect pairs were plotted on a cost-effectiveness plane and used to estimate cost-effectiveness curves. No significant differences in costs and effects between the groups were found. At 12 months,total costs per patient and primary caregiver dyad were substantial: €77,832 for the intervention group and €75,201 for the usual care group (adjusted mean difference per dyad €4,149,95% CI -13,371 to 21,956,ICER 157,534). The main cost driver was informal care (66% of total costs),followed by patients' day treatment and costs of hospital and long-term care facility admissions (23%). Based on the cost-effectiveness acceptability curves,the maximum probability that the intervention was considered cost-effective in comparison with usual care reached 0.4 for the outcome QALY per patient-caregiver dyad and 0.6 for the caregivers' incidence of depression and/or anxiety disorders regardless of the willingness to pay. The annual costs of caring for a person with dementia were substantial with informal care being by far the largest contributor to the total societal costs. Based on this study,family meetings cannot be considered a cost-effective intervention strategy in comparison with usual care. ISRCTN register,ISRCTN90163486."," Trials. 2013 Sep 22;14():305. ","Netherlands",2013,"Any dementia","Caregiver support",null,null,null,"Cost-utility"]
[20,"Leach MJ,Francis A,Ziaian T. Improving the health and well-being of community-dwelling caregivers of dementia sufferers: study protocol of a randomized controlled trial of structured meditation training. J Altern Complement Med. 2014 Feb;20(2):136-41. ","doi: 10.1089/acm.2013.0170. ","Leach MJ,Francis A,Ziaian T."," Improving the health and well-being of community-dwelling caregivers of dementia sufferers: study protocol of a randomized controlled trial of structured meditation training.","Caring for a person with dementia can be an unrelenting and burdensome task,one that is often detrimental to the caregiver's health,well-being,and functionality. The enduring stress and frustration of the caregiver role can also contribute to poorer outcomes for dementia sufferers. Building on growing clinical interest in the capacity for Transcendental Meditation(®) (TM; a relaxation technique) to reduce stress and anxiety in healthy workers,this study examines whether similar improvements could be experienced by dementia caregivers. The study objective was to ascertain whether a TM program can improve psychological stress,quality of life,affect,and cognitive performance of dementia caregivers. The study was a pilot prospective,single-center,randomized wait-list controlled trial with two parallel arms. Community-dwelling carers of persons with diagnosed dementia,residing in metropolitan Adelaide,South Australia,were included in this study. Participants will be randomly assigned to a 13-hour TM training program or wait-list control over 12 weeks. Primary outcomes include quality of life and stress. Secondary outcomes include affect,cognitive performance,cost-effectiveness,and study feasibility. Outcomes will be assessed at baseline,week 12 (postintervention),and week 24 (follow-up). Results are expected to be available early in 2014. This project responds to a need for robust evidence of the clinical and economic effectiveness of TM for the management of caregiver stress. If Transcendental Meditation is shown to be effective,it could indicate a simple,cost-effective,and easily implemented strategy to assist many of the growing numbers of caregivers to cope with the demanding and often difficult caregiver role."," J Altern Complement Med. 2014 Feb;20(2):136-41. ","Australia",2014,"Any dementia","Support",null,null,null,"Cost-utility"]
[21,"Touchon J,Lachaine J,Beauchemin C,Granghaud A,Rive B,Bineau S. The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer's disease to nursing homes: cost-effectiveness analysis in France. Eur J Health Econ. 2014 Nov;15(8):791-800. ","doi: 10.1007/s10198-013-0523-y. ","Touchon J,Lachaine J,Beauchemin C,Granghaud A,Rive B,Bineau S."," The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer's disease to nursing homes: cost-effectiveness analysis in France.","The costs associated with the care of Alzheimer's disease patients are very high,particularly those associated with nursing home placement. The combination of a cholinesterase inhibitor (ChEI) and memantine has been shown to significantly delay admission to nursing homes as compared to treatment with a ChEI alone. The objective of this cost-effectiveness analysis was to evaluate the economic impact of the concomitant use of memantine and ChEI compared to ChEI alone. Markov modelling was used in order to simulate transitions over time among three discrete health states (non-institutionalised,institutionalised and deceased). Transition probabilities were obtained from observational studies and French national statistics,utilities from a previous US survey and costs from French national statistics. The analysis was conducted from societal and healthcare system perspectives. Mean time to nursing home admission was 4.57 years for ChEIs alone and 5.54 years for combination therapy,corresponding to 0.98 additional years,corresponding to a gain in quality adjusted life years (QALYs) of 0.25. From a healthcare system perspective,overall costs were €98,609 for ChEIs alone and €90,268 for combination therapy,representing cost savings of €8,341. From a societal perspective,overall costs were €122,039 and €118,721,respectively,representing cost savings of €3,318. Deterministic and probabilistic (Monte Carlo simulations) sensitivity analyses indicated that combination therapy would be the dominant strategy in most scenarios. In conclusion,combination therapy with memantine and a ChEI is a cost-saving alternative compared to ChEI alone as it is associated with lower cost and increased QALYs from both a societal and a healthcare perspective."," Eur J Health Econ. 2014 Nov;15(8):791-800. ","France",2014,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility"]
[22,"Clare L,Bayer A,Burns A,Corbett A,Jones R,Knapp M,Kopelman M,Kudlicka A,Leroi I,Oyebode J,Pool J,Woods B,Whitaker R. Goal-oriented cognitive rehabilitation in early-stage dementia: study protocol for a multi-centre single-blind randomised controlled trial (GREAT). Trials. 2013 May 27;14():152. ","doi: 10.1186/1745-6215-14-152. ","Clare L,Bayer A,Burns A,Corbett A,Jones R,Knapp M,Kopelman M,Kudlicka A,Leroi I,Oyebode J,Pool J,Woods B,Whitaker R."," Goal-oriented cognitive rehabilitation in early-stage dementia: study protocol for a multi-centre single-blind randomised controlled trial (GREAT).","Preliminary evidence suggests that goal-oriented cognitive rehabilitation (CR) may be a clinically effective intervention for people with early-stage Alzheimer's disease,vascular or mixed dementia and their carers. This study aims to establish whether CR is a clinically effective and cost-effective intervention for people with early-stage dementia and their carers. In this multi-centre,single-blind randomised controlled trial,480 people with early-stage dementia,each with a carer,will be randomised to receive either treatment as usual or cognitive rehabilitation (10 therapy sessions over 3 months,followed by 4 maintenance sessions over 6 months). We will compare the effectiveness of cognitive rehabilitation with that of treatment as usual with regard to improving self-reported and carer-rated goal performance in areas identified as causing concern by people with early-stage dementia; improving quality of life,self-efficacy,mood and cognition of people with early-stage dementia; and reducing stress levels and ameliorating quality of life for carers of participants with early-stage dementia. The incremental cost-effectiveness of goal-oriented cognitive rehabilitation compared to treatment as usual will also be examined. If the study confirms the benefits and cost-effectiveness of cognitive rehabilitation,it will be important to examine how the goal-oriented cognitive rehabilitation approach can most effectively be integrated into routine health-care provision. Our aim is to provide training and develop materials to support the implementation of this approach following trial completion."," Trials. 2013 May 27;14():152. ","UK",2013,"Alzheimer’s,Vascular dementia","Cognitive therapies",null,null,null,"Cost-utility"]
[23,"Banerjee S,Hellier J,Romeo R,Dewey M,Knapp M,Ballard C,Baldwin R,Bentham P,Fox C,Holmes C,Katona C,Lawton C,Lindesay J,Livingston G,McCrae N,Moniz-Cook E,Murray J,Nurock S,Orrell M,O'Brien J,Poppe M,Thomas A,Walwyn R,Wilson K,Burns A. Study of the use of antidepressants for depression in dementia: the HTA-SADD trial--a multicentre,randomised,double-blind,placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine. Health Technol Assess. 2013 Feb;17(7):1-166. ","doi: 10.3310/hta17070.","Banerjee S,Hellier J,Romeo R,Dewey M,Knapp M,Ballard C,Baldwin R,Bentham P,Fox C,Holmes C,Katona C,Lawton C,Lindesay J,Livingston G,McCrae N,Moniz-Cook E,Murray J,Nurock S,Orrell M,O'Brien J,Poppe M,Thomas A,Walwyn R,Wilson K,Burns A."," Study of the use of antidepressants for depression in dementia: the HTA-SADD trial--a multicentre,randomised,double-blind,placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine.","Depression is common in dementia,causing considerable distress and other negative impacts. Treating it is a clinical priority,but the evidence base is sparse and equivocal. This trial aimed to determine clinical effectiveness of sertraline and mirtazapine in reducing depression 13 weeks post randomisation compared with placebo. Multicentre,parallel-group,double-blind placebo-controlled randomised controlled trial of the clinical effectiveness of sertraline and mirtazapine with 13- and 39-week follow-up. Nine English old-age psychiatry services. A pragmatic trial. Eligibility: probable or possible Alzheimer's disease (AD),depression (4+ weeks) and Cornell Scale for Depression in Dementia (CSDD) score of 8+. clinically too critical (e.g. suicide risk); contraindication to medication; taking antidepressants; in another trial; and having no carer. (1) Sertraline; (2) mirtazapine; and (3) placebo,all with normal care. Target doses: 150 mg of sertraline or 45 mg of mirtazapine daily. CSDD score. Randomisation: Allocated 1 : 1 : 1 through Trials Unit,independently of trial team. Stratified block randomisation by centre,with randomly varying block sizes; computer-generated randomisation. Blinding: Double blind: medication and placebo identical for each antidepressant. Referring clinicians,research workers,participants and pharmacies were blind. Statisticians blind until analyses completed. Numbers randomised: 326 participants randomised (111 placebo,107 sertraline and 108 mirtazapine). Differences in CSDD at 13 weeks from an adjusted linear-mixed model: mean difference (95% CI) placebo-sertraline 1.17 (-0.23 to 2.78; p = 0.102); placebo-mirtazapine 0.01 (-1.37 to 1.38; p = 0.991); and mirtazapine-sertraline 1.16 (-0.27 to 2.60; p = 0.112). Placebo group had fewer adverse reactions (29/111,26%) than sertraline (46/107,43%) or mirtazapine (44/108,41%; p = 0.017); 39-week mortality equal,five deaths in each group. This is a trial with negative findings but important clinical implications. The data suggest that the antidepressants tested,given with normal care,are not clinically effective (compared with placebo) for clinically significant depression in AD. This implies a need to change current practice of antidepressants being the first-line treatment of depression in AD. From the data generated we formulated the following recommendations for future work. (1) The secondary analyses presented here suggest that there would be value in carrying out a placebo-controlled trial of the clinical effectiveness and cost-effectiveness of mirtazapine in the management of Behavioural and Psychological Symptoms of Dementia. (2) A conclusion from this study is that it remains both ethical and essential for trials of new medication for depression in dementia to have a placebo arm. (3) Further research is required to evaluate the impact that treatments for depression in people with dementia can have on their carers not only in terms of any impacts on their quality of life,but also the time they spend care-giving. (4) There is a need for research into alternative biological and psychological therapies for depression in dementia. These could include evaluations of new classes of antidepressants (such as venlafaxine) or antidementia medication (e.g. cholinesterase inhibitors). (5) Research is needed to investigate the natural history of depression in dementia in the community when patients are not referred to secondary care services. (6) Further work is needed to investigate the cost modelling results in this rich data set,investigating carer burden and possible moderators to the treatment effects. (7) There is scope for reanalysis of the primary outcome in terms of carer and participant CSDD results."," Health Technol Assess. 2013 Feb;17(7):1-166. ","UK",2013,"Alzheimer’s","Antidepressants",null,null,null,"Unclear"]
[24,"Woods RT,Bruce E,Edwards RT,Elvish R,Hoare Z,Hounsome B,Keady J,Moniz-Cook ED,Orgeta V,Orrell M,Rees J,Russell IT. REMCARE: reminiscence groups for people with dementia and their family caregivers - effectiveness and cost-effectiveness pragmatic multicentre randomised trial. Health Technol Assess. 2012;16(48):v-xv,1-116. ","doi: 10.3310/hta16480. ","Woods RT,Bruce E,Edwards RT,Elvish R,Hoare Z,Hounsome B,Keady J,Moniz-Cook ED,Orgeta V,Orrell M,Rees J,Russell IT."," REMCARE: reminiscence groups for people with dementia and their family caregivers - effectiveness and cost-effectiveness pragmatic multicentre randomised trial.","The aim of the REMiniscence groups for people with dementia and their family CAREgivers (REMCARE) study was to assess the effectiveness and cost-effectiveness of joint reminiscence groups for people with dementia and their family caregivers as compared with usual care. A multicentre,pragmatic randomised controlled trial with two parallel arms - an intervention group and a usual-care control group - was carried out. A restricted dynamic method of randomisation was used with an overall allocation ratio of 1 : 1,restricted to ensure intervention groups of a viable size. Assessments,blind to treatment allocation,were carried out at baseline,3 months and 10 months (primary end point). Most participants were recruited through NHS Memory Clinics and Community Mental Health Teams for older people. Assessments were usually carried out in the person's home,and treatment groups were held in a variety of community settings. A total of 488 individuals (mean age 77.5 years) with mild to moderate dementia (meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria),who were initially living in the community,and who had a relative or other caregiver maintaining regular contact,who could act as an informant and was willing and able to participate in the intervention,were recruited to the study. Most carers were spouses (71%). A total of 350 dyads completed the study. The intervention consisted of joint reminiscence groups held weekly for 12 consecutive weeks,followed by monthly maintenance sessions for a further 7 months. The sessions followed a treatment manual,and were led by two trained facilitators in each centre,supported by a number of volunteers. Up to 12 dyads were invited to attend each group. The primary outcome measures were self-reported quality of life for the person with dementia and psychological distress for the carer [General Health Questionnaire-28 item version (GHQ-28)]. Secondary outcome measures included autobiographical memory and activities of daily living for the person with dementia,carer stress for the carer and mood,relationship quality and service use and costs for both parties. The intention-to-treat analysis identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes [self-reported quality of life in Alzheimer's disease: mean difference 0.07,standard error (SE) 0.65; F = 0.48; p = 0.53]. Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a subscale of the GHQ-28 at the 10-month end point (mean difference 1.25,SE 0.5; F = 8.28; p = 0.04). Compliance analyses suggested some benefits for people with dementia who attended more reminiscence sessions; however,carers attending more groups showed increased caregiving stress. Use of health- and social-care services was modest,with no significant difference in service use between conditions. Owing to negligible difference in quality-adjusted life-year gains (derived from European Quality of Life-5 Dimensions) between the conditions the planned full economic analysis was curtailed. This trial does not provide support for the effectiveness or cost-effectiveness of joint reminiscence groups for people with dementia and their carers. Although there may be some beneficial effects for people with dementia who attend sessions as planned,this must be viewed in the context of raised anxiety and stress in their carers. The reasons for these discrepant outcomes need to be explored further,and may necessitate reappraisal of the movement towards joint interventions. Current Controlled Trials ISRCTN42430123. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 16,No. 48. See the HTA programme website for further project information."," Health Technol Assess. 2012;16(48):v-xv,1-116. ","UK",2012,"Any dementia","Other psychological therapies",null,null,null,"Cost-utility"]
[25,"Laakkonen ML,Hölttä EH,Savikko N,Strandberg TE,Suominen M,Pitkälä KH. Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial. Trials. 2012 Aug 7;13():133. ","doi: 10.1186/1745-6215-13-133.","Laakkonen ML,Hölttä EH,Savikko N,Strandberg TE,Suominen M,Pitkälä KH."," Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial.","After diagnosis of a dementing illness,patients and their spouses have many concerns related to the disease and their future. This often leads to poor psychological well-being and reduced health-related quality of life (HRQoL) of the family. Support for self-management skills has been proven to be an effective method to improve prognosis of asthma,heart failure and osteoarthritis. However,self-management interventions have not been studied in dementia. Therefore,our aim was to examine,in an objective-oriented group intervention,the efficacy of self-management support program (SMP) on the HRQoL of dementia patients and their spousal caregivers as well as on the sense of competence and psychological well-being of caregivers. During the years 2011 to 12,160 dementia patients and their spouses will be recruited from memory clinics and randomized into two arms: 80 patients for group-based SMP sessions including topics selected by the participants,80 patients will serve as controls in usual community care. Sessions may include topics on dementia,community services,active lifestyle and prevention for cognitive decline,spousal relationship,future planning and emotional well-being. The patients and spouses will have their separate group sessions (ten participants per group) once a week for eight weeks. Main outcome measures will be patients' HRQoL (15D) and spousal caregivers' HRQoL (RAND-36),and sense of competence (SCQ). Secondary measures will be caregivers' psychological well-being (GHQ-12) and coping resources,patients' depression,cognition and signs of frailty. Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two-year follow-up. This is a 'proof-of-concept' study to explore the efficacy of group support for self-management skills among dementia families. It will also provide data on cost-effectiveness of the intervention. ACTRN12611001173987."," Trials. 2012 Aug 7;13():133. ","Finland",2012,"Any dementia","Other psychological therapies",null,null,null,"Cost-utility"]
[26,"Teljeur C,Flattery M,Harrington P,O'Neill M,Moran PS,Murphy L,Ryan M. Cost-effectiveness of prion filtration of red blood cells to reduce the risk of transfusion-transmitted variant Creutzfeldt-Jakob disease in the Republic of Ireland. Transfusion. 2012 Nov;52(11):2285-93. ","doi: 10.1111/j.1537-2995.2012.03637.x. ","Teljeur C,Flattery M,Harrington P,O'Neill M,Moran PS,Murphy L,Ryan M."," Cost-effectiveness of prion filtration of red blood cells to reduce the risk of transfusion-transmitted variant Creutzfeldt-Jakob disease in the Republic of Ireland.","Variant Creutzfeldt-Jakob disease (vCJD) is a rare,progressive fatal noninflammatory neurodegenerative disease. Ireland has the second highest rate of vCJD in the world with an ongoing risk of vCJD transmission through blood transfusion. Prion-removing filters have been developed to reduce the risk of vCJD transmission. This study aimed to evaluate the cost-effectiveness of implementing a policy of prion filtration of red blood cells (RBCs) in the Republic of Ireland. A cost-effectiveness model was developed to simulate the likelihood of RBC recipients developing clinical vCJD as a result of being transfused with infected RBCs. Model variables were collected from published literature and expert opinion. Costs were estimated based on the processing changes required to implement prion filtration. In the absence of prion filtration,it is estimated that two individuals will develop clinical vCJD arising from RBC transfusions over a 10-year time horizon. The discounted life-years lost will be 18.5 years. With prion filtration,there will be no deaths or life-years lost. The discounted cost of universal prion filtration is €68.2 million over 10 years with a corresponding incremental cost-effectiveness ratio of €3.7 million per life-year gained. In 25.3% of simulations there were no deaths from vCJD infection through infected blood transfusions,irrespective of prion filtration. Prion filtration is considered not cost-effective by traditional measures. Although numerous non-cost-effective blood safety strategies have been implemented in the past,consideration should be given to the most efficient use of finite resources in transfusion medicine."," Transfusion. 2012 Nov;52(11):2285-93. ","Ireland",2012,"CJD","Prevention",null,null,null,"Cost-effectiveness"]
[27,"Shearer J,Green C,Ritchie CW,Zajicek JP. Health state values for use in the economic evaluation of treatments for Alzheimer's disease. Drugs Aging. 2012 Jan 1;29(1):31-43. ","doi: 10.2165/11597380-000000000-00000. ","Shearer J,Green C,Ritchie CW,Zajicek JP."," Health state values for use in the economic evaluation of treatments for Alzheimer's disease.","Alzheimer's disease (AD) is a chronic,progressive,neurodegenerative disease that places a heavy burden on people with the condition,their families and carers,health care systems and society in general. Health-related quality of life (HR-QOL) in patients deteriorates as the cognitive,behavioural and functional symptoms of AD develop. The human and financial cost of AD is forecast to grow rapidly as populations age,and those responsible for planning and financing health care face the challenge of allocating increasingly scarce resources against current and future interventions targeted towards AD. These include calls for early detection and diagnosis,preventative strategies,new medications,residential care,supportive care,and meeting the needs of carers as well as patients. Health care funders in many health systems now require a demonstration of the value of new interventions through a comparison of benefits in terms of improvements in HR-QOL and costs relative to those of competing or existing practices. Changes in HR-QOL provide the basis for the calculation of the quality-adjusted life-year (QALY),a key outcome used in economic evaluations to compare treatments within and between different disease conditions. The objective of this systematic review was to provide a summary of the published health state values (utilities) for AD patients and their carers that are currently available to estimate QALYs for use in health economic evaluations of interventions in AD. The health care literature was searched for articles published in English between 2000 and 2011,using keywords and variants including 'quality-adjusted life years','health state indicators','health utilities' and the specific names of generic measures of HR-QOL and health state valuation techniques. Databases searched included MEDLINE,EMBASE,NHS EED,PsycINFO and ISI Web of Science. This review identified 12 studies that reported utility values associated with health states in AD. Values for AD health states categorized according to cognitive impairment (where 1 = perfect health and 0 = dead) ranged from mild AD (0.52-0.73) to moderate AD (0.30-0.53) to severe AD (0.12-0.49). Utility values were almost all based on two generic measures of HR-QOL: the EQ-5D and Health Utility Index mark 2/3 (HUI2/3). There were no health state values estimated from condition- or disease-specific measures of HR-QOL. The review also identified 18 published cost-utility analyses (CUAs) of treatments for AD. The CUAs incorporated results from only three of the identified health state valuation studies. Twelve CUAs relied on the same study for health state values. We conclude that the literature on health state values in AD is limited and overly reliant on a single symptom (cognition) to describe disease progression. Other approaches to characterizing disease progression in AD based on multiple outcomes or dependency may be better predictors of costs and utilities in economic evaluations. Patient and proxy ratings were poorly correlated,particularly in patients with more advanced AD. However,proxy ratings displayed the validity and reliability across the entire range of AD severity needed to detect long-term changes relevant to economic evaluation. Further longitudinal research of patient and carer HR-QOL based on multidimensional measures of outcome and utilities is needed."," Drugs Aging. 2012 Jan 1;29(1):31-43. ","International",2012,"Alzheimer’s","None or unclear",null,null,null,"Cost-utility"]
[28,"Lachaine J,Beauchemin C,Legault M,Bineau S. Economic evaluation of the impact of memantine on time to nursing home admission in the treatment of Alzheimer disease. Can J Psychiatry. 2011 Oct;56(10):596-604. ","","Lachaine J,Beauchemin C,Legault M,Bineau S."," Economic evaluation of the impact of memantine on time to nursing home admission in the treatment of Alzheimer disease.","An observational study showed that combining memantine with a cholinesterase inhibitor (ChEI) treatment significantly delayed admission to nursing homes in patients with Alzheimer disease (AD). Our study aimed to evaluate the economic impact of the concomitant use of memantine and a ChEI,compared with a ChEI alone,in a Canadian population of patients with AD. A cost-utility analysis using a Markov model during a 7-year time horizon was performed according to a societal and Canadian health care system perspective. The Markov model includes the following states: noninstitutionalized,institutionalized,and deceased. The model includes transition probabilities for institutionalization and death,adjusted with mortality rates specific to AD. Utilities associated with institutionalization and noninstitutionalization were included. For the health care system perspective,costs of medication as well as costs of care provided in the community and in nursing homes were considered. For the societal perspective,costs of direct care and supervision provided by caregivers were added. From both perspectives,the concomitant use of a ChEI and memantine is a dominant strategy,compared with the use of a ChEI alone. On a per patient basis,there was a gain of 0.26 quality-adjusted life years with the treatment including memantine and cost decreases of Can$21 391 and Can$30 512,respectively,for the societal and health care system perspective. This economic evaluation indicates that institutionalization is the largest cost component in AD management and that the use of memantine,combined with a ChEI,to treat AD is a cost-effective alternative,compared with the use of a ChEI alone."," Can J Psychiatry. 2011 Oct;56(10):596-604. ","Canada",2011,"Alzheimer’s","Memantine",null,null,null,"Cost-utility"]
[29,"Charlesworth G,Burnell K,Beecham J,Hoare Z,Hoe J,Wenborn J,Knapp M,Russell I,Woods B,Orrell M. Peer support for family carers of people with dementia,alone or in combination with group reminiscence in a factorial design: study protocol for a randomised controlled trial. Trials. 2011 Sep 15;12():205. ","doi: 10.1186/1745-6215-12-205.","Charlesworth G,Burnell K,Beecham J,Hoare Z,Hoe J,Wenborn J,Knapp M,Russell I,Woods B,Orrell M."," Peer support for family carers of people with dementia,alone or in combination with group reminiscence in a factorial design: study protocol for a randomised controlled trial.","Peer support interventions can improve carer wellbeing and interventions that engage both the carer and person with dementia can have significant mutual benefits. Existing research has been criticised for inadequate rigour of design or reporting. This paper describes the protocol for a complex trial that evaluates one-to-one peer support and a group reminiscence programme,both separately and together,in a factorial design. A 2 × 2 factorial multi-site randomised controlled trial of individual peer support and group reminiscence interventions for family carers and people with dementia in community settings in England,addressing both effectiveness and cost-effectiveness. The methods described in this protocol have implications for research into psychosocial interventions,particularly complex interventions seeking to test both individual and group approaches."," Trials. 2011 Sep 15;12():205. ","UK",2011,"Any dementia","Support",null,null,null,"Unclear"]
[30,"Rive B,Aarsland D,Grishchenko M,Cochran J,Lamure M,Toumi M. Cost-effectiveness of memantine in moderate and severe Alzheimer's disease in Norway. Int J Geriatr Psychiatry. 2012 Jun;27(6):573-82. ","doi: 10.1002/gps.2755.","Rive B,Aarsland D,Grishchenko M,Cochran J,Lamure M,Toumi M."," Cost-effectiveness of memantine in moderate and severe Alzheimer's disease in Norway.","The cost-effectiveness of memantine for the treatment of moderate and severe Alzheimer's disease has been assessed in several European countries. Objective of the study was to assess it in Norwegian settings. This cost-utility analysis used a Markov modelling approach to simulate the evolution of patients until their need for full-time care (FTC) over a 5-year period. FTC was defined as a patient becoming either dependent or institutionalised. Transition probabilities were estimated using a newly developed predictive equation of time to FTC. Health resource use and utilities were obtained from the Scandinavian Study of Cost and Quality of Life in Alzheimer's Disease study,and mortality was obtained from the Oslo study. Memantine efficacy was based on a meta-analysis of six large trials. The model compared memantine with its alternative in this population,that is no pharmacological treatment or background therapy with acetylcholinesterase inhibitors. The model underwent extensive sensitivity analyses. In Norway,memantine was found to delay the need for FTC by 4.4 weeks compared with standard care and was associated with increased quality-adjusted life years. Memantine was the dominant strategy with cost savings of €3739 (30 041 NOK) per patient. The probability of being the dominant strategy was 98.8%. This result was confirmed across multiple sensitivity analyses. The model suggests that memantine prolongs time to FTC for no additional cost to the healthcare system and society. It can be regarded as a cost-effective choice in the management of moderate and severe Alzheimer's disease."," Int J Geriatr Psychiatry. 2012 Jun;27(6):573-82. ","Norway",2012,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility"]
[31,"Jones C,Edwards RT,Hounsome B. A systematic review of the cost-effectiveness of interventions for supporting informal caregivers of people with dementia residing in the community. Int Psychogeriatr. 2012 Jan;24(1):6-18. ","doi: 10.1017/S1041610211001207. ","Jones C,Edwards RT,Hounsome B."," A systematic review of the cost-effectiveness of interventions for supporting informal caregivers of people with dementia residing in the community.","Dementia places a huge demand on healthcare services; however,a large proportion of the cost is borne by informal caregivers. With the number of people affected by dementia set to increase in the future,there is a need for research to consider the effects of interventions on informal caregivers as well as on the individuals with dementia. This paper seeks to systematically review the existing evidence on the cost-effectiveness of interventions to support informal caregivers of people with dementia residing in the community. A range of electronic databases was searched. Studies were included if both costs and outcome measures for informal caregivers of people with dementia residing in the community were reported for an intervention. Both pharmacological and non-pharmacological interventions were included. Quality of study was assessed using the Drummond ten-item checklist for economic evaluations and results were presented through narrative synthesis. Twelve studies were included in the review; of these only four reported a significant difference in the outcome measure for caregivers. At present few published studies report costs in enough detail to provide evidence of the effectiveness and cost-effectiveness of interventions for supporting caregivers. Future trials need to collect caregiver data alongside patient data in order to increase the evidence base for intervention effectiveness. Further research is required to establish the effectiveness and cost-effectiveness of both pharmacological and non-pharmacological approaches."," Int Psychogeriatr. 2012 Jan;24(1):6-18. ","International",2012,"Any dementia","Support",null,null,null,"Unclear"]
[32,"Zhang Y,Kivipelto M,Solomon A,Wimo A. Cost-effectiveness of a health intervention program with risk reductions for getting demented: results of a Markov model in a Swedish/Finnish setting. J Alzheimers Dis. 2011;26(4):735-44. ","doi: 10.3233/JAD-2011-110065. ","Zhang Y,Kivipelto M,Solomon A,Wimo A."," Cost-effectiveness of a health intervention program with risk reductions for getting demented: results of a Markov model in a Swedish/Finnish setting.","Risk scores based on modifiable factors have recently been developed for dementia. This study aims to estimate the cost-effectiveness of a potential preventive intervention program meant to lower the score related to increased dementia risk. Analyses were based on a Markov model adapted to Swedish circumstances. Risk score categories and risk probabilities were derived from the Cardiovascular Risk Factors,Aging and Incidence of Dementia (CAIDE) study in Finland. Figures of costs,utilities,and mortality were obtained from literature or databases. One-way sensitivity analysis and probabilistic sensitivity analysis were carried out to investigate the robustness of the model and to identify which model inputs had most impact on the results. In the base case,the usual care had a cost of 621,000 SEK and utilities of 11.8438 quality-adjusted life year (QALYs). The intervention had a cost of 599,026 SEK and utilities of 11.8950 QALYs. The cost was 21,974 SEK lower in the intervention with 0.0511 QALYs gained over a 20 years horizon,indicating absolute dominance. The support for cost-effectiveness was insensitive to changes in the value of QALY for demented,mortality,and risk of dementia. If the intervention program was assumed to run every year,the incremental cost-effectiveness ratio did not show absolute dominance but was still under the willingness-to-pay level. The probabilistic sensitivity analysis indicated cost effectiveness in 67% of the samplings given a willingness-to-pay level of 600,000 SEK/year. This is a promising outlook for future research on preventive interventions in dementia,emphasizing the need of conducting multi-domain randomized trials."," J Alzheimers Dis. 2011;26(4):735-44. ","Sweden,Finland",2011,"Any dementia","Prevention",null,null,null,"Cost-utility"]
[33,"Getsios D,Blume S,Ishak KJ,Maclaine G,Hernández L. An economic evaluation of early assessment for Alzheimer's disease in the United Kingdom. Alzheimers Dement. 2012 Jan;8(1):22-30. ","doi: 10.1016/j.jalz.2010.07.001. ","Getsios D,Blume S,Ishak KJ,Maclaine G,Hernández L."," An economic evaluation of early assessment for Alzheimer's disease in the United Kingdom.","Diagnosing and treating patients with Alzheimer's disease (AD) at an early stage should improve the quality of life of the patient and caregiver. In the United Kingdom,cost-effectiveness of early assessment of individuals presenting with subjective memory complaints and treating those with AD with donepezil was evaluated. A discrete event simulation of AD progression and the effect of treatment interventions was developed. Patient-level data from donepezil trials and a 7-year follow-up registry were used to model correlated longitudinal rates of change in cognition,behavior,and function. Other epidemiological and health services data,including estimates of undiagnosed dementia and delays in diagnosis,were based on published sources. Simulated individuals were followed up for 10 years. In the base-case estimates,17 patients need to be assessed to diagnose one patient with AD,resulting in an average assessment cost of £4100 ($6000; $1 US = £0.68 UK) per patient diagnosed (2007 cost year). In comparison with a scenario without early assessment or pharmacologic treatment,early assessment reduces health care costs by £3600 ($5300) per patient and societal costs by £7750 ($11,400). Savings are also substantial compared with treatment without early assessment,averaging £2100 ($3100) in health care costs,and £5700 ($8400) in societal costs. Results are most sensitive to estimates of patient care costs and the probability of patients reporting subjective memory complaints. In probabilistic sensitivity analysis,early assessment leads to savings or is highly cost-effective in the majority of cases. Although early assessment has significant up-front costs,identifying AD patients at an early stage results in cost savings and health benefits compared with no treatment or treatment in the absence of early assessment."," Alzheimers Dement. 2012 Jan;8(1):22-30. ","UK",2012,"Alzheimer’s","Diagnosis,Donepezil",null,null,null,"Cost-effectiveness"]
[34,"Cappell J,Herrmann N,Cornish S,Lanctôt KL. The pharmacoeconomics of cognitive enhancers in moderate to severe Alzheimer's disease. CNS Drugs. 2010 Nov;24(11):909-27. ","doi: 10.2165/11539530-000000000-00000.","Cappell J,Herrmann N,Cornish S,Lanctôt KL."," The pharmacoeconomics of cognitive enhancers in moderate to severe Alzheimer's disease.","Alzheimer's disease is associated with a substantial economic impact on patients,their caregivers and society. Due to the current rise in the aging population,the prevalence and impact of Alzheimer's disease are expected to increase greatly. The cost of caring for someone with Alzheimer's disease is magnified in the more severe stages of the disease. There are four cognitive enhancers commonly used for the treatment of Alzheimer's disease: three cholinesterase inhibitors (donepezil,rivastigmine and galantamine) and one NMDA receptor antagonist (memantine). Of these,donepezil and memantine have been approved in many countries as pharmacological treatments for moderate to severe Alzheimer's disease,while donepezil,rivastigmine and galantamine are approved treatments for mild to moderate Alzheimer's disease. While cost effectiveness has been well studied in mild to moderate Alzheimer's disease,the cost-benefit information for drug therapy in moderate to severe Alzheimer's disease is less clear. This article reviews the pharmacoeconomic data available on these four drugs,with a specific focus on moderate to severe Alzheimer's disease,including economic burden,cost drivers,clinical outcomes and pharmacoeconomic studies. A key driver of the cost of Alzheimer's disease is the severity of the disease,indicating that the ability to stabilize the disease state is a potential source of cost savings. Drug therapies that can limit increases in behavioural problems and cognitive and functional impairment,and postpone institutionalization without an increase in longevity may serve to reduce the economic burden on Alzheimer's disease patients. The data suggest that,while the available,approved agents offer only modest improvements in clinical outcomes,they could be cost-effective treatments for moderate to severe Alzheimer's disease when viewed from the societal perspective. For memantine and donepezil,data are available that suggest that the cost of these drugs is offset by the clinical and societal benefits provided by slowing the progression of Alzheimer's disease. While there are few head-to-head comparison trials,the similarity in costs of the treatments and efficacy against placebo suggest that cost effectiveness will not be substantially different among treatments. More studies that examine longitudinal resource utilization and its relationship to drug treatment in the moderate to severe stages are needed to clarify cost benefit in this population and possibly differentiate between individual medications."," CNS Drugs. 2010 Nov;24(11):909-27. ","International",2010,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine",null,null,null,"Unclear"]
[35,"Pitkala KH, Raivio MM, Laakkonen ML, Tilvis RS, Kautiainen H, Strandberg TE. Exercise rehabilitation on home-dwelling patients with Alzheimer's disease--a randomized, controlled trial. Study protocol. Trials. 2010 Oct 6;11():92. ","doi: 10.1186/1745-6215-11-92.","Pitkala KH, Raivio MM, Laakkonen ML, Tilvis RS, Kautiainen H, Strandberg TE."," Exercise rehabilitation on home-dwelling patients with Alzheimer's disease--a randomized, controlled trial.","Besides cognitive decline, Alzheimer's disease (AD) leads to physical disability, need for help and permanent institutional care. The trials investigating effects of exercise rehabilitation on physical functioning of home-dwelling older dementia patients are still scarce. The aim of this study is to investigate the effectiveness of intensive exercise rehabilitation lasting for one year on mobility and physical functioning of home-dwelling patients with AD. During years 2008-2010, patients with AD (n = 210) living with their spousal caregiver in community are recruited using central AD registers in Finland, and they are offered exercise rehabilitation lasting for one year. The patients are randomized into three arms: 1) tailored home-based exercise twice weekly 2) group-based exercise twice weekly in rehabilitation center 3) control group with usual care and information of exercise and nutrition. Main outcome measures will be Guralnik's mobility and balance tests and FIM-test to assess physical functioning. Secondary measures will be cognition, neuropsychiatric symptoms according to the Neuropsychiatric Inventory, caregivers' burden, depression and health-related quality of life (RAND-36). Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two year follow-up. To our knowledge this is the first large scale trial exploring whether home-dwelling patients with AD will benefit from intense and long-lasting exercise rehabilitation in respect to their mobility and physical functioning. It will also provide data on cost-effectiveness of the intervention. ACTRN12608000037303."," Study protocol. Trials. 2010 Oct 6;11():92. ","Finland",2010,"Alzheimer’s","Exercise",null,null,null,"Cost-utility"]
[36,"Gitlin LN, Hodgson N, Jutkowitz E, Pizzi L. The cost-effectiveness of a nonpharmacologic intervention for individuals with dementia and family caregivers: the tailored activity program. Am J Geriatr Psychiatry. 2010 Jun;18(6):510-9. ","doi: 10.1097/JGP.0b013e3181c37d13.","Gitlin LN, Hodgson N, Jutkowitz E, Pizzi L."," The cost-effectiveness of a nonpharmacologic intervention for individuals with dementia and family caregivers: the tailored activity program.","To evaluate cost-effectiveness of the Tailored Activity Program (TAP) for individuals with dementia and family caregivers. Cost-effectiveness study of a two-group randomized controlled trial involving 60 patients-caregiver dyads randomized to intervention or wait-list control. Participants' homes in Philadelphia region. Caregivers were aged ≥ 21 years, lived with patients, and provided ≥ 4 hours of daily care. Patients had moderate dementia and behavioral symptoms Eight sessions of occupational therapy over 4 months to identify patients' preserved capabilities, previous roles, habits and interests, develop customized activities, and train families in their use. Incremental cost-effectiveness ratios (ICER) expressed as the cost to bring about one additional unit of benefit measured by caregiver hours per day \"doing things\" and hours per day \"being on duty.\" Decision tree and Monte Carlo analyses tested robustness of the economic models. Total average intervention cost was $941.63 per day. Intervention caregivers saved one extra hour per day \"doing things\" at a cost of $2.37/day and one extra hour per day \"being on duty\" at a cost of $1.10/day. Monte Carlo showed that TAP was cost-effective 79.2% of the time for \"doing things\" and 79.6% of the time for \"being on duty.\" Varying the cost assumptions did not change cost-effectiveness. Findings suggest that investment in TAP is cost-effective and afforded families an important, limited and highly valued resource, needed time off from caregiving. This nonpharmacologic approach should be considered part of the clinical management of dementia."," Am J Geriatr Psychiatry. 2010 Jun;18(6):510-9. ","USA",2010,"Any dementia","Exercise",null,null,null,"Cost-effectiveness"]
[37,"Nagy B, Brennan A, Brandtmüller A, Thomas SK, Sullivan SD, Akehurst R. Assessing the cost-effectiveness of the rivastigmine transdermal patch for Alzheimer's disease in the UK using MMSE- and ADL-based models. Int J Geriatr Psychiatry. 2011 May;26(5):483-94. ","doi: 10.1002/gps.2551. ","Nagy B, Brennan A, Brandtmüller A, Thomas SK, Sullivan SD, Akehurst R."," Assessing the cost-effectiveness of the rivastigmine transdermal patch for Alzheimer's disease in the UK using MMSE- and ADL-based models.","Assess long-term cost-effectiveness of rivastigmine patch in Alzheimer's disease (AD) management in the UK, using cognitive and functional models based on clinical trial efficacy data. Incremental costs and Quality Adjusted Life Years (QALYs) associated with rivastigmine patch and capsule treatment versus best supportive care (BSC) were calculated using two economic models, one based solely on Mini-Mental State Examination (MMSE) scores, and one also incorporating activities of daily living (ADL) scores. The clinical pathway was populated with data from a clinical trial of rivastigmine patch (9.5 mg/24 h) and capsules (12 mg/day) versus placebo. Costs were based on the UK health and social care costs and basic UK National Health Service (NHS) prices. Disease progression was modelled beyond the trial period over 5 years using published equations to predict natural decline in AD patients. Base case costing variables included drugs, clinical monitoring, and institutionalization. The MMSE model estimated incremental costs per QALY of £10 579 for rivastigmine patch and £15 154 for capsule versus BSC. The MMSE-ADL model estimated incremental costs per QALY of £9114 for rivastigmine patch and £13 758 for capsules. The main difference between the models was a greater number of institutionalized days avoided for rivastigmine versus BSC estimated by the MMSE-ADL model. Both the MMSE and MMSE-ADL models suggest that rivastigmine patch and capsules are cost-effective treatments versus BSC. Incorporating ADL evidence makes a marginal but important difference to estimates in this case. Future economic evaluations of AD treatment should include measures of both cognition and functioning."," Int J Geriatr Psychiatry. 2011 May;26(5):483-94. ","UK",2011,"Alzheimer’s","Rivastigmine",null,null,null,"Cost-utility"]
[38,"Suh GH. Modeling the cost-effectiveness of galantamine for mild to moderately severe Alzheimer's disease in Korea. Value Health. 2009 Nov-Dec;12 Suppl 3():S49-54. ","doi: 10.1111/j.1524-4733.2009.00627.x.","Suh GH."," Modeling the cost-effectiveness of galantamine for mild to moderately severe Alzheimer's disease in Korea.","The aim of the study was to determine the cost-effectiveness, from the third-party payer viewpoint, of galantamine compared with usual care in the treatment of mild to moderately severe Alzheimer's disease (AD). An existing Markov model was adapted to Korea to predict long-term outcomes over a 5-year time horizon and to estimate the cost-effectiveness of galantamine for the treatment of AD. The model structure is informed by a review of national and international literature on the clinical and cost-effectiveness of galantamine and on the costs and outcomes associated with treatment for AD. The main outcome measure used was the cost per quality-adjusted life year (QALY) gained. All costs were indexed to US$ (2007 value). Multivariate probabilistic sensitivity analysis and scenario analysis were undertaken to assess uncertainty in the results. The study findings indicate that the clinical benefits on AD progression from galantamine treatment resulted in an incremental cost per QALY gained of US$4939 over 5 years (vs. usual care). Probabilistic sensitivity analysis and cost-effectiveness acceptability curve suggest that the probability of galantamine treatment having an incremental cost per QALY over US$6740 is zero. Incremental cost per QALY gained according to scenario analyses ranged from US$2271 to US$8335. These findings suggest that the use of galantamine may be a cost-effective use of Korean national health-care resources, considering the gross domestic product per capita of US$21,695 in 2007."," Value Health. 2009 Nov-Dec;12 Suppl 3():S49-54. ","Korea",2009,"Alzheimer’s","Galantamine",null,null,null,"Cost-utility"]
[39,"Rive B, Grishchenko M, Guilhaume-Goulant C, Katona C, Livingston G, Lamure M, Toumi M, François C. Cost effectiveness of memantine in Alzheimer's disease in the UK. J Med Econ. 2010;13(2):371-80. ","doi: 10.3111/13696998.2010.491347","Rive B, Grishchenko M, Guilhaume-Goulant C, Katona C, Livingston G, Lamure M, Toumi M, François C."," Cost effectiveness of memantine in Alzheimer's disease in the UK.","This analysis assesses the cost-effectiveness of memantine for the treatment of moderate-to-severe Alzheimer's disease (AD) in the UK. This cost-utility analysis was based on a Markov model. The model simulated 5-year progress of patients with AD until they need full-time care (FTC), defined as a patient becoming either dependent or institutionalised. Transition probabilities were based on a predictive equation, derived from the London and South-East Region epidemiological study. Resource use, utilities and mortality were obtained from the same study. Memantine efficacy was based on a meta-analysis of six large trials. The model compared memantine to its alternative in the UK, i.e. no pharmacological treatment or background therapy with acetylcholinesterase inhibitors. Memantine was found to delay the need to FTC by 6 weeks compared with current practice in the UK. It was associated with increased quality-adjusted life-years and cost savings to the healthcare system (probability of this outcome was 96%). The projections were made assuming that benefits from the 6-month treatment were sustained over time, which is regarded as the main limitation. The model underwent extensive sensitivity analyses, which confirmed the base-case findings. The model suggests that memantine delays the need for FTC and decreases cost. It can be regarded as a cost-effective choice in the management of moderate and severe AD."," J Med Econ. 2010;13(2):371-80. ","UK",2010,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility"]
[40,"Getsios D, Blume S, Ishak KJ, Maclaine GD. Cost effectiveness of donepezil in the treatment of mild to moderate Alzheimer's disease: a UK evaluation using discrete-event simulation. Pharmacoeconomics. 2010;28(5):411-27. ","doi: 10.2165/11531870-000000000-00000. ","Getsios D, Blume S, Ishak KJ, Maclaine GD."," Cost effectiveness of donepezil in the treatment of mild to moderate Alzheimer's disease: a UK evaluation using discrete-event simulation.","Recommendations in the UK suggest restricting treatment of Alzheimer's disease with cholinesterase inhibitors, on cost-effectiveness grounds, to patients with moderate cognitive decline. As the economic analyses that informed these recommendations have been the subject of debate, we sought to address the potential limitations of existing models and produce estimates of donepezil treatment cost effectiveness in the UK using the most recent available data and simulation techniques. A discrete-event simulation was developed that predicts progression of Alzheimer's disease through correlated changes in cognition, behavioural disturbance and function. Patient-level data from seven randomized, placebo-controlled donepezil trials and a 7-year follow-up registry provided the basis for modeling longitudinal outcomes. Individuals in the simulation were assigned unique demographic and clinical characteristics and then followed for 10 years, with severity of disease tracked on continuous scales. Patient mix and costs were developed from UK-specific literature. Analyses were run for severity subgroups to evaluate outcomes for sub-populations with disease of mild versus moderate severity from both a healthcare payer and societal perspective. All costs are reported in pound, year 2007 values, and all outcomes are discounted at 3.5% per annum. Over 10 years, treatment of all patients with mild to moderate disease reduces overall direct medical costs by an average of over pound2300 per patient. When unpaid caregiver time is also taken into consideration, savings increase to over pound4700 per patient. Compared with untreated patients, patients receiving donepezil experience a discounted gain in QALYs averaging 0.11, with their caregivers gaining, on average, 0.01 QALYs. For the subset of patients starting treatment with more severe disease, savings are more modest, averaging about pound1600 and pound3750 from healthcare and societal perspectives, respectively. In probabilistic sensitivity analyses, donepezil dominated no treatment between 57% and 62% of replications when only medical costs were considered, and between 74% and 79% of replications when indirect costs were included, with results more favourable for treatment initiation in the mild versus moderate severity stages of the disease. Although the simulation results are not definitive, they suggest that donepezil leads to health benefits and cost savings when used to treat mild to moderately severe Alzheimer's disease in the UK. They also indicate that both benefits and savings may be greatest when treatment is started while patients are still in the mild stages of Alzheimer's disease."," Pharmacoeconomics. 2010;28(5):411-27. ","UK",2010,"Alzheimer’s","Donepezil",null,null,null,"Cost-utility"]
[41,"Jones R, Sheehan B, Phillips P, Juszczak E, Adams J, Baldwin A, Ballard C, Banerjee S, Barber B, Bentham P, Brown R, Burns A, Dening T, Findlay D, Gray R, Griffin M, Holmes C, Hughes A, Jacoby R, Johnson T, Jones R, Knapp M, Lindesay J, McKeith I, McShane R, Macharouthu A, O'Brien J, Onions C, Passmore P, Raftery J, Ritchie C, Howard R, DOMINO-AD team. DOMINO-AD protocol: donepezil and memantine in moderate to severe Alzheimer's disease - a multicentre RCT. Trials. 2009 Jul 24;10():57. ","doi: 10.1186/1745-6215-10-57. ","Jones R, Sheehan B, Phillips P, Juszczak E, Adams J, Baldwin A, Ballard C, Banerjee S, Barber B, Bentham P, Brown R, Burns A, Dening T, Findlay D, Gray R, Griffin M, Holmes C, Hughes A, Jacoby R, Johnson T, Jones R, Knapp M, Lindesay J, McKeith I, McShane R, Macharouthu A, O'Brien J, Onions C, Passmore P, Raftery J, Ritchie C, Howard R, DOMINO-AD team."," DOMINO-AD protocol: donepezil and memantine in moderate to severe Alzheimer's disease - a multicentre RCT.","Alzheimer's disease (AD) is the commonest cause of dementia. Cholinesterase inhibitors, such as donepezil, are the drug class with the best evidence of efficacy, licensed for mild to moderate AD, while the glutamate antagonist memantine has been widely prescribed, often in the later stages of AD. Memantine is licensed for moderate to severe dementia in AD but is not recommended by the England and Wales National Institute for Health and Clinical Excellence. However, there is little evidence to guide clinicians as to what to prescribe as AD advances; in particular, what to do as the condition progresses from moderate to severe. Options include continuing cholinesterase inhibitors irrespective of decline, adding memantine to cholinesterase inhibitors, or prescribing memantine instead of cholinesterase inhibitors. The aim of this trial is to establish the most effective drug option for people with AD who are progressing from moderate to severe dementia despite treatment with donepezil. DOMINO-AD is a pragmatic, 15 centre, double-blind, randomized, placebo controlled trial. Patients with AD, currently living at home, receiving donepezil 10 mg daily, and with Standardized Mini-Mental State Examination (SMMSE) scores between 5 and 13 are being recruited. Each is randomized to one of four treatment options: continuation of donepezil with memantine placebo added; switch to memantine with donepezil placebo added; donepezil and memantine together; or donepezil placebo with memantine placebo. 800 participants are being recruited and treatment continues for one year. Primary outcome measures are cognition (SMMSE) and activities of daily living (Bristol Activities of Daily Living Scale). Secondary outcomes are non-cognitive dementia symptoms (Neuropsychiatric Inventory), health related quality of life (EQ-5D and DEMQOL-proxy), carer burden (General Health Questionnaire-12), cost effectiveness (using Client Service Receipt Inventory) and institutionalization. These outcomes are assessed at baseline, 6, 18, 30 and 52 weeks. All participants will be subsequently followed for 3 years by telephone interview to record institutionalization. There is considerable debate about the clinical and cost effectiveness of anti-dementia drugs. DOMINO-AD seeks to provide clear evidence on the best treatment strategies for those managing patients at a particularly important clinical transition point. Current controlled trials ISRCTN49545035."," Trials. 2009 Jul 24;10():57. ","UK",2009,"Alzheimer’s","Donepezil,Memantine",null,null,null,"Unclear"]
[42,"Weimer DL, Sager MA. Early identification and treatment of Alzheimer's disease: social and fiscal outcomes. Alzheimers Dement. 2009 May;5(3):215-26. ","doi: 10.1016/j.jalz.2009.01.028.","Weimer DL, Sager MA."," Early identification and treatment of Alzheimer's disease: social and fiscal outcomes.","Alzheimer's disease (AD) is a progressive neurodegenerative disease that places substantial burdens on those who provide support for family members with declining cognitive and functional abilities. Many AD patients eventually require formal long-term care services because of the absence, exhaustion, or inability of family members to provide care. The costs of long-term care, and especially nursing home care, often deplete private financial resources, placing a substantial burden on state Medicaid programs. Current evidence suggests that pharmacological treatments and caregiver interventions can delay entry into nursing homes and potentially reduce Medicaid costs. However, these cost savings are not being realized because many patients with AD are either not diagnosed or diagnosed at late stages of the disease, and have no access to Medicare-funded caregiver support programs. A Monte Carlo cost-benefit analysis, based on estimates of parameters available in the medical literature, suggests that the early identification and treatment of AD have the potential to result in large, positive net social benefits as well as positive net savings for states and the federal government. These findings indicate that the early diagnosis and treatment of AD are not only socially desirable in terms of increasing economic efficiency, but also fiscally attractive from both state and federal perspectives. These findings also suggest that failure to fund effective caregiver interventions may be fiscally unsound."," Alzheimers Dement. 2009 May;5(3):215-26. ","USA",2009,"Alzheimer’s","Diagnosis",null,null,null,"Cost-benefit"]
[43,"Meeuwsen EJ, German P, Melis RJ, Adang EM, Golüke-Willemse GA, Krabbe PF, de Leest BJ, van Raak FH, Schölzel-Dorenbos CJ, Visser MC, Wolfs CA, Vliek S, Rikkert MG. Cost-effectiveness of post-diagnosis treatment in dementia coordinated by Multidisciplinary Memory Clinics in comparison to treatment coordinated by general practitioners: an example of a pragmatic trial. J Nutr Health Aging. 2009 Mar;13(3):242-8.","","Meeuwsen EJ, German P, Melis RJ, Adang EM, Golüke-Willemse GA, Krabbe PF, de Leest BJ, van Raak FH, Schölzel-Dorenbos CJ, Visser MC, Wolfs CA, Vliek S, Rikkert MG."," Cost-effectiveness of post-diagnosis treatment in dementia coordinated by Multidisciplinary Memory Clinics in comparison to treatment coordinated by general practitioners: an example of a pragmatic trial.","With the rising number of dementia patients with associated costs and the recognition that there is room for improvement in the provision of dementia care, the question arises on how to efficiently provide high quality dementia care. To describe the design of a study to determine multidisciplinary memory clinics' (MMC) effectiveness and cost-effectiveness in post-diagnosis treatment and care-coordination of dementia patients and their caregivers compared to the post-diagnosis treatment and care-coordination by general practitioners (GP). Next, this article provides the theoretical background of pragmatic trials, often needed in complex interventions, with the AD- Euro study as an example of such a pragmatic approach in a clinical trial. The study is a pragmatic multicentre, randomised clinical trial with an economic evaluation alongside, which aims to recruit 220 independently living patients with a new dementia diagnosis and their informal caregivers. After baseline measurements, patient and caregiver are allocated to the treatment arm MMC or GP and are visited for follow up measurements at 6 and 12 months. Primary outcome measures are Health Related Quality of Life of the patient as rated by the caregiver using the Quality of Life in Alzheimer's Disease instrument (Qol-AD) and self-perceived caregiving burden of the informal caregiver measured using the Sense of Competence Questionnaire (SCQ). To establish cost-effectiveness a cost-utility analysis using utilities generated by the EuroQol instrument (EQ-5D) will be conducted from a societal perspective. Analyses will be done in an intention-to-treat fashion. The inclusion period started in January 2008 and will commence until at least December 2008. After finalising follow up the results of the study are expected to be available halfway through 2010. The study will provide an answer to whether follow-up of dementia patients can best be done in specialised outpatient memory clinics or in primary care settings with regard to quality and costs. It will enable decision making on how to provide good and efficient health care services in dementia. ClinicalTrials.gov Identifier NCT00554047."," J Nutr Health Aging. 2009 Mar;13(3):242-8.","Netherlands",2009,"Any dementia","Memory clinic",null,null,null,"Cost-utility"]
[44,"Suh GH, Han C. Mental health economics, health service provision, and the practice of geriatric psychiatry. Curr Opin Psychiatry. 2008 Nov;21(6):546-50. ","doi: 10.1097/YCO.0b013e32830f1bd5.","Suh GH, Han C."," Mental health economics, health service provision, and the practice of geriatric psychiatry.","Economic evaluation is becoming more and more important as a means to assist policy makers in choosing the best intervention or treatment against a pervasive scarcity of resources relative to the demands. Health service provision and the practice of geriatric psychiatry are closely associated with costs and outcomes of health economics. Recently published literature raising unanswered questions in these areas is reviewed. Some studies on the costs, outcomes, and cost-effectiveness of certain interventions or treatments (e.g. respite care, home-visiting community service) compared with usual strategies show that these are not optimal in terms of health economics. The updated guidance by the National Institute for Health and Clinical Excellence that cholinesterase inhibitors should be used only for moderate severity dementia on the grounds of cost-effectiveness has been heavily criticized. Mental health provision for older people varies across 'developed' and 'developing' countries. Updated findings provide better understanding of recent progress and issues on mental health economics, health service provision, and the practice of geriatric psychiatry. The application of health economics to the field of mental health should make complicated issues simple and explicit. Constructive criticisms and scientific debates will hasten the development of better tools or methodologies to evaluate the cost-effectiveness of current and new interventions or treatments."," Curr Opin Psychiatry. 2008 Nov;21(6):546-50. ","International",2008,"Any dementia","Any anticholinesterase",null,null,null,"Unclear"]
[45,"Webert KE, Cserti CM, Hannon J, Lin Y, Pavenski K, Pendergrast JM, Blajchman MA. Proceedings of a Consensus Conference: pathogen inactivation-making decisions about new technologies. Transfus Med Rev. 2008 Jan;22(1):1-34. ","doi: 10.1016/j.tmrv.2007.09.001.","Webert KE, Cserti CM, Hannon J, Lin Y, Pavenski K, Pendergrast JM, Blajchman MA."," Proceedings of a Consensus Conference: pathogen inactivation-making decisions about new technologies.","Significant progress has been made in reducing the risk of pathogen transmission to transfusion recipients. Nonetheless, there remains a continuing risk of transmission of viruses, bacteria, protozoa, and prions to recipients. These include many of the viruses for which specific screening tests exist as well as pathogens for which testing is currently not being done, including various species of bacteria, babesiosis, variant Creutzfeld-Jacob disease, hepatitis A virus, human herpes virus 8, chikungunya virus, Chagas disease, and malaria. Pathogen inactivation (PI) technologies potentially provide an additional way to protect the blood supply from emerging agents and also provide additional protection against both known and as-yet-unidentified agents. However, the impact of PI on product quality and recipient safety remains to be determined. The purpose of this consensus conference was to bring together international experts in an effort to consider the following issues with respect to PI: implementation criteria; licensing requirements; blood service and clinical issues; risk management issues; cost-benefit impact; and research requirements. These proceedings are provided to make available to the transfusion medicine community the considerable amount of important information presented at this consensus conference."," Transfus Med Rev. 2008 Jan;22(1):1-34. ","International",2008,"CJD","Prevention",null,null,null,"Unclear"]
[46,"Wartenberg D. EMFs: cutting through the controversy. Public Health Rep. 1996 May-Jun;111(3):204-17. ","","Wartenberg D."," EMFs: cutting through the controversy.","SOME SCIENTISTS ALLEGE that exposure to electric and magnetic fields generated by electric power delivery systems is responsible for certain cancers (particularly among children), reproductive dysfunction, birth defects, neurological disorders, and Alzheimer's disease. Some activist groups believe the hazard to be so great that they are calling for closure of schools and other public facilities near power lines and restructuring of the entire electric power delivery system. Some utilities, with equally strong beliefs, claim that there is no proof of risk. They argue that the science is sufficient to confirm the alleged associations and that no action is warranted. This article provides a broad overview of the current scientific data on the association between magnetic fields and disease, providing summary risk estimates and highlighting the uncertainties in the data. Building on this information, three complementary policy perspectives are presented. From a fiscally conservative perspective, the cost of mitigation already instituted far exceeds the health protection offered and mitigation of other environmental risks is more important. From a cost-benefit view, only limited, low-cost mitigation should be considered. These measures, however, would substantially reduce many exposures. From an aggressive exposure reduction perspective, much can be done to reduce exposure by personal and societal actions. If the suggested association is validated, substantially reducing magnetic field exposure could lower health risks."," Public Health Rep. 1996 May-Jun;111(3):204-17. ","Unknown",1996,"Alzheimer’s","Prevention",null,null,null,"Cost-benefit"]
[47,"van Knippenberg RJ, de Vugt ME, Ponds RW, Myin-Germeys I, Verhey FR. Dealing with daily challenges in dementia (deal-id study): effectiveness of the experience sampling method intervention 'Partner in Sight' for spousal caregivers of people with dementia: design of a randomized controlled trial. BMC Psychiatry. 2016 May 11;16():136. ","doi: 10.1186/s12888-016-0834-5. ","van Knippenberg RJ, de Vugt ME, Ponds RW, Myin-Germeys I, Verhey FR."," Dealing with daily challenges in dementia (deal-id study): effectiveness of the experience sampling method intervention 'Partner in Sight' for spousal caregivers of people with dementia: design of a randomized controlled trial.","There is an urgent need for psychosocial interventions that effectively support dementia caregivers in daily life. The Experience Sampling Methodology (ESM) offers the possibility to provide a more dynamic view of caregiver functioning. ESM-derived feedback may help to redirect caregivers' behavior towards situations that elicit positive emotions and to increase their feelings of competence in the caretaking process. This paper presents the design of a study that evaluates the process characteristics and effects of the ESM-based intervention 'Partner in Sight'. A randomized controlled trial with 90 spousal caregivers of people with dementia will be conducted. Participants will be randomly assigned to the experimental (6-week ESM intervention including feedback), pseudo-experimental (6-week ESM intervention without feedback), or control group (care as usual). Assessments will be performed pre- and post-intervention and at 2-, and 6-month follow-up. Main outcomes will be sense of competence, perceived control, momentary positive affect, and psychological complaints (depressive symptoms, perceived stress, anxiety, momentary negative affect). In addition to the effect evaluation, a process and economic evaluation will be conducted to investigate the credibility and generalizability of the intervention, and its cost-effectiveness. The potential effects of the ESM intervention may help caregivers to endure their care responsibilities and prevent them from becoming overburdened. This is the first ESM intervention for caregivers of people with dementia. The results of this study, therefore, provide a valuable contribution to the growing knowledge on m-health interventions for dementia caregivers. Dutch Trial Register NTR4847 ; date registered Oct 9, 2014."," BMC Psychiatry. 2016 May 11;16():136. ","Netherlands",2016,"Any dementia","Support",null,null,null,"Unclear"]
[48,"de Souto Barreto P, Denormandie P, Lepage B, Armaingaud D, Rapp T, Chauvin P, Vellas B, Rolland Y. Effects of a long-term exercise programme on functional ability in people with dementia living in nursing homes: Research protocol of the LEDEN study, a cluster randomised controlled trial. Contemp Clin Trials. 2016 Mar;47():289-95. ","doi: 10.1016/j.cct.2016.02.004.","de Souto Barreto P, Denormandie P, Lepage B, Armaingaud D, Rapp T, Chauvin P, Vellas B, Rolland Y."," Effects of a long-term exercise programme on functional ability in people with dementia living in nursing homes: Research protocol of the LEDEN study, a cluster randomised controlled trial.","Exercise may lead to improvements on functional ability, physical function, and neuropsychiatric symptoms (particularly depression) in people with dementia (PWD). However, high-quality randomised controlled trial (RCT), controlling for the socialisation aspect of group-based exercise interventions, and designed to delay the declines on the functional ability of PWD in the nursing home (NH) setting is almost inexistent. This article describes the protocol of the LEDEN study, an exercise RCT for PWD living in NHs. LEDEN is a cluster-randomised controlled pilot trial composed of two research arms: exercise training (experimental group) and social/recreational activity (control group). Both interventions will be provided twice a week, for 60 min, during the 6-month intervention. The total duration of the study is 12 months, being six months of intervention plus six months of observational follow-up. Eight French NHs volunteered to participate in LEDEN; they have been randomised to either exercise intervention or social/recreational intervention in a 1:1 ratio. The primary objective is to investigate the effects of exercise, compared to a social/recreational intervention, on the ability of PWD living in NHs to perform activities of daily living (ADL). Secondary objectives are related with the cost-effectiveness of the interventions, and the effects of the interventions on patients' physical function, neuropsychiatric symptoms, pain, nutritional status, and the incidence of falls and fractures. LEDEN will provide the preliminary evidence needed to inform the development of larger and more complex interventions using exercise or non-exercise social interventions."," Contemp Clin Trials. 2016 Mar;47():289-95. ","France",2016,"Any dementia","Exercise",null,null,null,"Unclear"]
[49,"Tanajewski L, Franklin M, Gkountouras G, Berdunov V, Harwood RH, Goldberg SE, Bradshaw LE, Gladman JR, Elliott RA. Economic Evaluation of a General Hospital Unit for Older People with Delirium and Dementia (TEAM Randomised Controlled Trial). PLoS One. 2015;10(12):e0140662. ","doi: 10.1371/journal.pone.0140662. ","Tanajewski L, Franklin M, Gkountouras G, Berdunov V, Harwood RH, Goldberg SE, Bradshaw LE, Gladman JR, Elliott RA."," Economic Evaluation of a General Hospital Unit for Older People with Delirium and Dementia (TEAM Randomised Controlled Trial).","One in three hospital acute medical admissions is of an older person with cognitive impairment. Their outcomes are poor and the quality of their care in hospital has been criticised. A specialist unit to care for older people with delirium and dementia (the Medical and Mental Health Unit, MMHU) was developed and then tested in a randomised controlled trial where it delivered significantly higher quality of, and satisfaction with, care, but no significant benefits in terms of health status outcomes at three months. To examine the cost-effectiveness of the MMHU for older people with delirium and dementia in general hospitals, compared with standard care. Six hundred participants aged over 65 admitted for acute medical care, identified on admission as cognitively impaired, were randomised to the MMHU or to standard care on acute geriatric or general medical wards. Cost per quality adjusted life year (QALY) gained, at 3-month follow-up, was assessed in trial-based economic evaluation (599/600 participants, intervention: 309). Multiple imputation and complete-case sample analyses were employed to deal with missing QALY data (55%). The total adjusted health and social care costs, including direct costs of the intervention, at 3 months was £7714 and £7862 for MMHU and standard care groups, respectively (difference -£149 (95% confidence interval [CI]: -298, 4)). The difference in QALYs gained was 0.001 (95% CI: -0.006, 0.008). The probability that the intervention was dominant was 58%, and the probability that it was cost-saving with QALY loss was 39%. At £20,000/QALY threshold, the probability of cost-effectiveness was 94%, falling to 59% when cost-saving QALY loss cases were excluded. The MMHU was strongly cost-effective using usual criteria, although considerably less so when the less acceptable situation with QALY loss and cost savings were excluded. Nevertheless, this model of care is worthy of further evaluation. ClinicalTrials.gov NCT01136148."," PLoS One. 2015;10(12):e0140662. ","UK",2015,"Any dementia","Disease management",null,null,null,"Cost-utility"]
[50,"Saint-Laurent Thibault C, Özer Stillman I, Chen S, Getsios D, Proskorovsky I, Hernandez L, Dixit S. Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer's type in the US. J Med Econ. 2015;18(11):930-43. ","doi: 10.3111/13696998.2015.1063501.","Saint-Laurent Thibault C, Özer Stillman I, Chen S, Getsios D, Proskorovsky I, Hernandez L, Dixit S."," Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer's type in the US.","This study evaluates the cost-effectiveness of memantine extended release (ER) as an add-on therapy to acetylcholinesterase inhibitor (AChEI) [combination therapy] for treatment of patients with moderate-to-severe Alzheimer's disease (AD) from both a healthcare payer and a societal perspective over 3 years when compared to AChEI monotherapy in the US. A phase III trial evaluated the efficacy and safety of memantine ER for treatment of AD patients taking an AChEI. The analysis assessed the long-term costs and health outcomes using an individual patient simulation in which AD progression is modeled in terms of cognition, behavior, and functioning changes. Input parameters are based on patient-level trial data, published literature, and publicly available data sources. Changes in anti-psychotic medication use are incorporated based on a published retrospective cohort study. Costs include drug acquisition and monitoring, total AD-related medical care, and informal care associated with caregiver time. Incremental cost-utility ratio (ICUR), life years, care time for caregiver, time in community and institution, time on anti-psychotics, time by disease severity, and time without severe symptoms are reported. Costs and health outcomes are discounted at 3% per annum. Considering a societal perspective over 3 years, this analysis shows that memantine ER combined with an AChEI provides better clinical outcomes and lower costs than AChEI monotherapy. Discounted average savings were estimated at $18,355 and $20,947 per patient and quality-adjusted life-years (QALYs) increased by an average of 0.12 and 0.13 from a societal and healthcare payer perspective, respectively. Patients on combination therapy spent an average of 4 months longer living at home and spend less time in moderate-severe and severe stages of the disease. Combination therapy for patients with moderate-to-severe AD is a cost-effective treatment compared to AChEI monotherapy in the US."," J Med Econ. 2015;18(11):930-43. ","USA",2015,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility"]
[51,"Handels RL, Joore MA, Tran-Duy A, Wimo A, Wolfs CA, Verhey FR, Severens JL. Early cost-utility analysis of general and cerebrospinal fluid-specific Alzheimer's disease biomarkers for hypothetical disease-modifying treatment decision in mild cognitive impairment. Alzheimers Dement. 2015 Aug;11(8):896-905. ","doi: 10.1016/j.jalz.2015.02.009. ","Handels RL, Joore MA, Tran-Duy A, Wimo A, Wolfs CA, Verhey FR, Severens JL."," Early cost-utility analysis of general and cerebrospinal fluid-specific Alzheimer's disease biomarkers for hypothetical disease-modifying treatment decision in mild cognitive impairment.","The study aimed to determine the room for improvement of a perfect cerebrospinal fluid (CSF) biomarker and the societal incremental net monetary benefit of CSF in subjects with mild cognitive impairment (MCI) assuming a hypothetical disease-modifying Alzheimer's disease (AD) treatment. A decision model compared current practice to a perfect biomarker and to two strategies positioning CSF as add-on test when current practice concluded the presence or absence of AD. The simulated MCI population was aged on average 68.3 and 49% had AD. The room for improvement by the perfect CSF test was 0.39 quality adjusted life years, €33,622 ($43,372) savings, 2.0 potential beneficial treatment years, and 1.3-year delay in dementia conversion. The results indicated more potential benefit from a biomarker positioned to verify subjects who are not expected to have AD (i.e., to prevent undertreatment) rather than to verify subjects expected to have AD (prevent overtreatment). Sensitivity analyses explored different CSF positions."," Alzheimers Dement. 2015 Aug;11(8):896-905. ","Netherlands",2015,"Alzheimer’s","Diagnosis",null,null,null,"Cost-utility"]
[52,"Krol M, Papenburg J, van Exel J. Does including informal care in economic evaluations matter? A systematic review of inclusion and impact of informal care in cost-effectiveness studies. Pharmacoeconomics. 2015 Feb;33(2):123-35. ","doi: 10.1007/s40273-014-0218-y. ","Krol M, Papenburg J, van Exel J."," Does including informal care in economic evaluations matter? A systematic review of inclusion and impact of informal care in cost-effectiveness studies.","Informal care makes an important contribution to societal welfare. However, it may involve substantial time costs and can have a considerable negative effect on the health and well-being of informal caregivers. These costs and effects of informal caregiving are often excluded in economic evaluations of healthcare interventions. The impact of this exclusion on the outcomes of these evaluations is largely unknown. This study aimed to explore the inclusion of informal care in economic evaluations and the potential impact of the costs and effects of informal caregiving on cost-effectiveness outcomes. A systematic review was conducted to identify economic evaluations of interventions in four distinct disease areas where informal care is potentially important: Alzheimer's disease, metastatic colorectal cancer, Parkinson's disease and rheumatoid arthritis. It was recorded how often economic evaluations included informal caregiving. Next, for the studies including informal care, the impact on cost-effectiveness outcomes was determined by removing informal care costs and effects of the cost-effectiveness calculations and recalculating the outcomes. The new cost-effectiveness outcomes were then compared with the original reported outcomes. The study identified 100 economic evaluations investigating interventions targeted at Alzheimer's disease (n = 25), metastatic colorectal cancer (n = 24), Parkinson's disease (n = 8) and rheumatoid arthritis (n = 43). Twenty-three of these evaluations (23 %) included costs and/or effects of informal caregiving: 64 % of the Alzheimer's disease studies, 0 % of the metastatic colorectal cancer studies, 13 % of Parkinson's disease studies and 14 % of rheumatoid arthritis studies. When informal care was included, this mostly concerned time costs. Studies rarely included both costs and effects. The effect of including or excluding informal care costs or effects on cost-effectiveness outcomes in most studies was modest, but in some studies the impact was strong. Most economic evaluations in the area of Alzheimer's disease include costs and/or effects related to informal caregiving. However, in other disease areas where informal caregiving is common it seems that the majority of economic evaluations ignore informal caregiving. The inclusion of informal care can have a strong impact on cost-effectiveness outcomes. Future economic evaluations should therefore consider the relevance of informal care in the context of their study, and either include these costs and effects or justify why they were excluded."," Pharmacoeconomics. 2015 Feb;33(2):123-35. ","International",2015,"Alzheimer’s","Informal care",null,null,null,"Unclear"]
[53,"Dixon J, Ferdinand M, D'Amico F, Knapp M. Exploring the cost-effectiveness of a one-off screen for dementia (for people aged 75 years in England and Wales). Int J Geriatr Psychiatry. 2015 May;30(5):446-52. ","doi: 10.1002/gps.4158. ","Dixon J, Ferdinand M, D'Amico F, Knapp M."," Exploring the cost-effectiveness of a one-off screen for dementia (for people aged 75 years in England and Wales).","This paper examines the numbers of people with dementia who could be diagnosed and the likely cost-effectiveness of a one-off screen for dementia for people aged 75 years in England and Wales. The study uses static decision modelling to compare a one-off screen for dementia with a no-screen scenario. Estimates for the model were drawn from systematic reviews, high-quality studies and government and administrative sources. A panel of experts also advised the study. An estimated 3514 people could be diagnosed as a result of screening, 2152 of whom would otherwise never receive a diagnosis. The study identified societal economic impact of between £3,649,794 (net costs) and £4,685,768 (net savings), depending on assumptions. Our analysis suggests that screening could be cost-effective, especially as treatments and social care interventions become more effective and if diagnosis by current routes remains low or occurs later than is optimal. This study was, however, limited by available evidence and a range of quality of life benefits, cost savings and potential harms could not be quantified. It was also beyond the scope of this study to consider dynamic factors such as repeat screening, mortality, disease trajectories or trends in the numbers of people with dementia. A larger study would be needed for this, involving more complex and innovative approaches to generating estimates for modelling. We did not compare population screening for people aged 75 years to other methods for increasing diagnosis rates."," Int J Geriatr Psychiatry. 2015 May;30(5):446-52. ","UK",2015,"Any dementia","Diagnosis",null,null,null,"Unclear"]
[54,"Davis JC, Bryan S, Marra CA, Hsiung GY, Liu-Ambrose T. Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia. Br J Sports Med. 2015 Oct;49(20):1343-7. ","doi: 10.1136/bjsports-2013-092743.","Davis JC, Bryan S, Marra CA, Hsiung GY, Liu-Ambrose T."," Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia.","Cognitive decline is one of the most prominent healthcare issues of the 21st century. Within the context of combating cognitive decline through behavioural interventions, physical activity is a promising approach. There is a dearth of health economic data in the area of behavioural interventions for dementia prevention. Yet, economic evaluations are essential for providing information to policy makers for resource allocation. It is essential we first address population and intervention-specific methodological challenges prior to building a larger evidence base. We use a cost-utility analysis conducted alongside the exercise for cognition and everyday living (EXCEL) study to illustrate methodological challenges specific to assessing the cost-effectiveness of behavioural interventions aimed at older adults at risk of cognitive decline. A cost-utility analysis conducted concurrently with a 6-month, three-arm randomised controlled trial (ie, the EXCEL study) was used as an example to identify and discuss methodological challenges. Both the aerobic training and resistance training interventions were less costly than twice weekly balance and tone classes. In critically evaluating the economic evaluation of the EXCEL study we identified four category-specific challenges: (1) analysing costs; (2) assessing quality-adjusted life-years; (3) Incomplete data; and (4) 'Intervention' activities of the control group. Resistance training and aerobic training resulted in healthcare cost saving and were equally effective to balance and tone classes after only 6 months of intervention. To ensure this population is treated fairly in terms of claims on resources, we first need to identify areas for methodological improvement."," Br J Sports Med. 2015 Oct;49(20):1343-7. ","Canada",2015,"Any dementia","Behavioural therapies,Prevention",null,null,null,"Cost-utility"]
[55,"Leroi I, Woolham J, Gathercole R, Howard R, Dunk B, Fox C, O'Brien J, Bateman A, Poland F, Bentham P, Burns A, Davies A, Forsyth K, Gray R, Knapp M, Newman S, McShane R, Ritchie C. Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial. Trials. 2013 Oct 23;14():349. ","doi: 10.1186/1745-6215-14-349. ","Leroi I, Woolham J, Gathercole R, Howard R, Dunk B, Fox C, O'Brien J, Bateman A, Poland F, Bentham P, Burns A, Davies A, Forsyth K, Gray R, Knapp M, Newman S, McShane R, Ritchie C."," Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial.","Assistive technology and telecare (ATT) are relatively new ways of delivering care and support to people with social care needs. It is claimed that ATT reduces the need for community care, prevents unnecessary hospital admission, and delays or prevents admission into residential or nursing care. The current economic situation in England has renewed interest in ATT instead of community care packages. However, at present, the evidence base to support claims about the impact and effectiveness of ATT is limited, despite its potential to mitigate the high financial cost of caring for people with dementia and the social and psychological cost to unpaid carers. ATTILA (Assistive Technology and Telecare to maintain Independent Living At Home for People with Dementia) is a pragmatic, multi-centre, randomised controlled trial over 104 weeks that compares outcomes for people with dementia who receive ATT and those who receive equivalent community services but not ATT. The study hypothesis is that fewer people in the ATT group will go into institutional care over the 4-year period for which the study is funded. The study aims to recruit 500 participants, living in community settings, with dementia or significant cognitive impairment, who have recently been referred to social services.Primary outcome measures are time in days from randomisation to institutionalisation and cost effectiveness. Secondary outcomes are caregiver burden, health-related quality of life in carers, number and severity of serious adverse events, and data on acceptability, applicability and reliability of ATT intervention packages. Assessments will be undertaken in weeks 0 (baseline), 12, 24, 52 and 104 or until institutionalisation or withdrawal of the participant from the trial. In a time of financial austerity, CASSRs in England are increasingly turning to ATT in the belief that it will deliver good outcomes for less money. There is an absence of robust evidence for the cost-effectiveness and benefit of using assistive technology and telecare. The ATTILA trial meets a pressing need for robust, generalisable evidence to either justify continuing investment or reappraise the appropriate scale of ATT use. Current Controlled Trials ISRCTN86537017."," Trials. 2013 Oct 23;14():349. ","UK",2013,"Any dementia","Telecare",null,null,null,"Unclear"]
[56,"Goldfeld KS, Hamel MB, Mitchell SL. The cost-effectiveness of the decision to hospitalize nursing home residents with advanced dementia. J Pain Symptom Manage. 2013 Nov;46(5):640-51. ","doi: 10.1016/j.jpainsymman.2012.11.007.","Goldfeld KS, Hamel MB, Mitchell SL."," The cost-effectiveness of the decision to hospitalize nursing home residents with advanced dementia.","Nursing home (NH) residents with advanced dementia commonly experience burdensome and costly hospitalizations that may not extend survival or improve quality of life. Cost-effectiveness analyses of decisions to hospitalize these residents have not been reported. To estimate the cost-effectiveness of 1) not having a do-not-hospitalize (DNH) order and 2) hospitalization for suspected pneumonia in NH residents with advanced dementia. NH residents from 22 NHs in the Boston area were followed in the Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life study conducted between February 2003 and February 2009. We conducted cost-effectiveness analyses of aggressive treatment strategies for advanced dementia residents living in NHs when they suffer from acute illness. Primary outcome measures included quality-adjusted life days (QALD) and quality-adjusted life years, Medicare expenditures, and incremental net benefits (INBs) over 15 months. Compared with a less aggressive strategy of avoiding hospital transfer (i.e., having DNH orders), the strategy of hospitalization was associated with an incremental increase in Medicare expenditures of $5972 and an incremental gain in quality-adjusted survival of 3.7 QALD. Hospitalization for pneumonia was associated with an incremental increase in Medicare expenditures of $3697 and an incremental reduction in quality-adjusted survival of 9.7 QALD. At a willingness-to-pay level of $100,000/quality-adjusted life years, the INBs of the more aggressive treatment strategies were negative and, therefore, not cost effective (INB for not having a DNH order, -$4958 and INB for hospital transfer for pneumonia, -$6355). Treatment strategies favoring hospitalization for NH residents with advanced dementia are not cost effective."," J Pain Symptom Manage. 2013 Nov;46(5):640-51. ","USA",2013,"Any dementia","Formal care",null,null,null,"Cost-utility"]
[57,"Peters JL, Anderson R, Hoyle M, Hyde C. Evolution of a cost-utility model of donepezil for Alzheimer's disease. Int J Technol Assess Health Care. 2013 Apr;29(2):147-54. ","doi: 10.1017/S026646231300007X. ","Peters JL, Anderson R, Hoyle M, Hyde C."," Evolution of a cost-utility model of donepezil for Alzheimer's disease.","The aim of this study was to describe the evolution of a cost-utility model used to inform the UK National Institute for Health and Clinical Excellence's (NICE) most recent decisions on the cost-utility of drug treatments for Alzheimer's disease (AD), and to explore the impact of structural assumptions on the cost-utility results. Changes informed by noted limitations of the decision model used in NICE's previous decisions (in 2006) were made cumulatively to the original decision model for donepezil compared with best supportive care (for patients with mild to moderate AD). Deterministic and probabilistic analyses were undertaken for each cumulative change of the model. The expected value of perfect information (EVPI) of parameter estimates and structural assumptions was also calculated. Cumulative changes to the decision model highlighted how the results of the original model (incremental cost-effectiveness ratio of £81,000 per quality-adjusted life-year gained) related to those of the new model (where donepezil was estimated to be cost-saving), mainly due to uncertainty in the incremental cost of donepezil treatment over best supportive care (ranging from -£600 to £3,000 per patient). The partial EVPI analysis reflected this finding where further information on treatment discontinuations and cost parameter estimates were shown to be valuable in terms of reducing decision uncertainty. Assessing the evolution of the cost-utility model helped to identify and explore structural differences between cohort-based models and is likely to be useful for decision models in other disease areas. This approach makes the structural uncertainty explicit, forcing decision makers to address structural uncertainty in addition to parameter uncertainty."," Int J Technol Assess Health Care. 2013 Apr;29(2):147-54. ","UK",2013,"Alzheimer’s","Donepezil",null,null,null,"Cost-utility"]
[58,"Alves J, Magalhães R, Thomas RE, Gonçalves OF, Petrosyan A, Sampaio A. Is there evidence for cognitive intervention in Alzheimer disease? A systematic review of efficacy, feasibility, and cost-effectiveness. Alzheimer Dis Assoc Disord. 2013 Jul-Sep;27(3):195-203. ","doi: 10.1097/WAD.0b013e31827bda55. ","Alves J, Magalhães R, Thomas RE, Gonçalves OF, Petrosyan A, Sampaio A."," Is there evidence for cognitive intervention in Alzheimer disease? A systematic review of efficacy, feasibility, and cost-effectiveness.","Several studies have shown that cognitive intervention may be beneficial for people with Alzheimer disease (AD), but literature reviews conducted so far, have yielded mixed and inconclusive results. In this work, through an extensive bibliographic search, we aim: (1) to analyze the efficacy of cognitive intervention in patients diagnosed with AD; (2) to provide an estimate of the feasibility of cognitive intervention; and (3) to review available cost-effectiveness data of this approach. Four randomized controlled trials of cognitive intervention, for patients diagnosed with AD that incorporated cognitive intervention and mock intervention control conditions, were included in the analysis. Only the domain of global cognitive functioning, as measured by Mini-Mental State Examination, showed significant intervention effects. No effects were observed in the remaining domains. Concerning feasibility, high rates of completion and adherence were found. A single randomized controlled trial, with unspecified dementia, suggested cognitive intervention to be cost-effective. Given the currently available dearth of well-controlled and focused trials in AD, these results should be carefully interpreted and remain to be confirmed in the future. There is a clear need for more high-quality research."," Alzheimer Dis Assoc Disord. 2013 Jul-Sep;27(3):195-203. ","International",2013,"Alzheimer’s","Cognitive therapies",null,null,null,"Unclear"]
[59,"Blom MM, Bosmans JE, Cuijpers P, Zarit SH, Pot AM. Effectiveness and cost-effectiveness of an internet intervention for family caregivers of people with dementia: design of a randomized controlled trial. BMC Psychiatry. 2013 Jan 10;13():17. ","doi: 10.1186/1471-244X-13-17. ","Blom MM, Bosmans JE, Cuijpers P, Zarit SH, Pot AM."," Effectiveness and cost-effectiveness of an internet intervention for family caregivers of people with dementia: design of a randomized controlled trial.","The number of people with dementia is rising rapidly as a consequence of the greying of the world population. There is an urgent need to develop cost effective approaches that meet the needs of people with dementia and their family caregivers. Depression, feelings of burden and caregiver stress are common and serious health problems in these family caregivers. Different kinds of interventions are developed to prevent or reduce the negative psychological consequences of caregiving. The use of internet interventions is still very limited, although they may be a cost effective way to support family caregivers in an earlier stage and diminish their psychological distress in the short and longer run. A pragmatic randomized controlled trial is designed to evaluate the effectiveness and cost-effectiveness of 'Mastery over Dementia', an internet intervention for caregivers of people with dementia. The intervention aims at prevention and decrease of psychological distress, in particular depressive symptoms. The experimental condition consists of an internet course with 8 sessions and a booster session over a maximum period of 6 months guided by a psychologist. Caregivers in the comparison condition receive a minimal intervention. In addition to a pre and post measurement, an intermediate measurement will be conducted. In addition, there will be two follow-up measurements 3 and 6 months after post-treatment in the experimental group only. To study the effectiveness of the intervention, depressive symptoms are used as the primary outcome, whereas symptoms of anxiety, role overload and caregiver perceived stress are used as secondary outcomes. To study which caregivers profit most of the internet intervention, several variables that may modify the impact of the intervention are taken into account. Regarding the cost-effectiveness, an economic evaluation will be conducted from a societal perspective. This study will provide evidence about the effectiveness and cost-effectiveness of an internet intervention for caregivers. If both can be shown, this might set the stage for the development of a range of internet interventions in the field of caregiving for people with dementia. This is even more important because future generations of caregivers will be more familiar with the use of internet. NTR-2051/RCT-DDB."," BMC Psychiatry. 2013 Jan 10;13():17. ","Netherlands",2013,"Any dementia","Support",null,null,null,"Unclear"]
[60,"Romeo R, Knapp M, Hellier J, Dewey M, Ballard C, Baldwin R, Bentham P, Burns A, Fox C, Holmes C, Katona C, Lawton C, Lindesay J, Livingston G, McCrae N, Moniz-Cook E, Murray J, Nurock S, O'Brien J, Poppe M, Thomas A, Walwyn R, Wilson K, Banerjee S. Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial. Br J Psychiatry. 2013 Feb;202():121-8. ","doi: 10.1192/bjp.bp.112.115212. ","Romeo R, Knapp M, Hellier J, Dewey M, Ballard C, Baldwin R, Bentham P, Burns A, Fox C, Holmes C, Katona C, Lawton C, Lindesay J, Livingston G, McCrae N, Moniz-Cook E, Murray J, Nurock S, O'Brien J, Poppe M, Thomas A, Walwyn R, Wilson K, Banerjee S."," Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial.","Depression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes. To evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia. A pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0-13 weeks and 0-39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods. There were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively. In terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers."," Br J Psychiatry. 2013 Feb;202():121-8. ","UK",2013,"Any dementia","Antidepressants",null,null,null,"Cost-utility"]
[61,"Djalalov S, Yong J, Beca J, Black S, Saposnik G, Musa Z, Siminovitch K, Moretti M, Hoch JS. Genetic testing in combination with preventive donepezil treatment for patients with amnestic mild cognitive impairment: an exploratory economic evaluation of personalized medicine. Mol Diagn Ther. 2012 Dec;16(6):389-99. ","doi: 10.1007/s40291-012-0010-7. ","Djalalov S, Yong J, Beca J, Black S, Saposnik G, Musa Z, Siminovitch K, Moretti M, Hoch JS."," Genetic testing in combination with preventive donepezil treatment for patients with amnestic mild cognitive impairment: an exploratory economic evaluation of personalized medicine.","To evaluate the cost effectiveness of genetic screening for the apolipoprotein (APOE) ε4 allele in combination with preventive donepezil treatment in comparison with the standard of care for amnestic mild cognitive impairment (AMCI) patients in Canada. We performed a cost-effectiveness analysis using a Markov model with a societal perspective and a time horizon of 30 years. For each strategy, we calculated quality-adjusted life-years (QALYs), using utilities from the literature. Costs were also based on the literature and, when appropriate, Ontario sources. One-way and probabilistic sensitivity analyses were performed. Expected value of perfect information (EVPI) analysis was conducted to explore the value of future research. The base case results in our exploratory study suggest that the combination of genetic testing and preventive donepezil treatment resulted in a gain of 0.027 QALYs and an incremental cost of $1,015 (in 2009 Canadian dollars [Can$]), compared with the standard of care. The incremental cost-effectiveness ratio (ICER) for the base case was Can$38,016 per QALY. The ICER was sensitive to the effectiveness of donepezil in slowing the rate of progression to Alzheimer's disease (AD), utility in AMCI patients, and AD and donepezil treatment costs. EVPI analysis showed that additional information on these parameters would be of value. Using presently available clinical evidence, this exploratory study illustrates that genetic testing combined with preventive donepezil treatment for AMCI patients may be economically attractive. Since our results were based on a secondary post hoc analysis, our study alone is insufficient to warrant recommending APOE genotyping in AMCI patients. Future research on the effectiveness of preventive donepezil as a targeted therapy is recommended."," Mol Diagn Ther. 2012 Dec;16(6):389-99. ","Canada",2012,"Any dementia","Diagnosis,Donepezil",null,null,null,"Cost-utility"]
[62,"Jones C, Edwards RT, Hounsome B. Health economics research into supporting carers of people with dementia: a systematic review of outcome measures. Health Qual Life Outcomes. 2012 Nov 26;10():142. ","doi: 10.1186/1477-7525-10-142.","Jones C, Edwards RT, Hounsome B."," Health economics research into supporting carers of people with dementia: a systematic review of outcome measures.","Advisory bodies, such as the National Institute for Health and Clinical Excellence (NICE) in the UK, advocate using preference based instruments to measure the quality of life (QoL) component of the quality-adjusted life year (QALY). Cost per QALY is used to determine cost-effectiveness, and hence funding, of interventions. QALYs allow policy makers to compare the effects of different interventions across different patient groups. Generic measures may not be sensitive enough to fully capture the QoL effects for certain populations, such as carers, so there is a need to consider additional outcome measures, which are preference based where possible to enable cost-effectiveness analysis to be undertaken. This paper reviews outcome measures commonly used in health services research and health economics research involving carers of people with dementia. An electronic database search was conducted in PubMed, Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the National Health Service Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment database. Studies were eligible for inclusion if they included an outcome measure for carers of people with dementia. 2262 articles were identified. 455 articles describing 361 studies remained after exclusion criteria were applied. 228 outcome measures were extracted from the studies. Measures were categorised into 44 burden measures, 43 mastery measures, 61 mood measures, 32 QoL measures, 27 social support and relationships measures and 21 staff competency and morale measures. The choice of instrument has implications on funding decisions; therefore, researchers need to choose appropriate instruments for the population being measured and the type of intervention undertaken. If an instrument is not sensitive enough to detect changes in certain populations, the effect of an intervention may be underestimated, and hence interventions which may appear to be beneficial to participants are not deemed cost-effective and are not funded. If this is the case, it is essential that additional outcome measures which detect changes in broader QoL are included, whilst still retaining preference based utility measures such as EQ-5D to allow QALY calculation for comparability with other interventions."," Health Qual Life Outcomes. 2012 Nov 26;10():142. ","International",2012,"Any dementia","Support",null,null,null,"Cost-utility"]
[63,"Pfeil AM, Kressig RW, Szucs TD. Alzheimer's dementia: budget impact and cost-utility analysis of a combination treatment of a cholinesterase inhibitor and memantine in Switzerland. Swiss Med Wkly. 2012 Nov 21;142():w13676. ","doi: 10.4414/smw.2012.13676.","Pfeil AM, Kressig RW, Szucs TD."," Alzheimer's dementia: budget impact and cost-utility analysis of a combination treatment of a cholinesterase inhibitor and memantine in Switzerland.","The objective of this study was to estimate the potential budget impact and cost-effectiveness of the combination treatment of a cholinesterase inhibitor and memantine in Switzerland. The prevalence of dementia according to European sources and future Swiss population data were used to estimate the number of patients with Alzheimer's dementia in Switzerland. Both direct and indirect costs calculated from Swiss sources were included. Utility estimates and transition probabilities were obtained from the published literature. A Markov model was used for the cost-utility analysis in order to calculate incremental cost-effectiveness ratios from a health care and a societal perspective. Assuming mono treatment (either a cholinesterase inhibitor or memantine), treatment costs would increase from CHF 22.7 million in 2012 to CHF 26.1 million in 2016, the additional yearly treatment costs for the combination treatment (cholinesterase inhibitor and memantine) would be between CHF 1.7 million and CHF 1.9 million. The Markov model compared health care costs of the mono treatment to costs of the combination treatment over five years. From a health care perspective, the combination treatment saved CHF 27,655 per patient over five years and CHF 248,895/quality adjusted life year compared to the mono treatment. Implementation of the reimbursed combination treatment would incur additional treatment costs of about CHF 10 million over five years. From a health care perspective, the combination treatment would decrease costs over five years by CHF 50 million. Based on long term considerations, the combination treatment was the dominant strategy over the mono treatment."," Swiss Med Wkly. 2012 Nov 21;142():w13676. ","Switzerland",2012,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility"]
[64,"Hyde C, Peters J, Bond M, Rogers G, Hoyle M, Anderson R, Jeffreys M, Davis S, Thokala P, Moxham T. Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer's disease: systematic review and economic model. Age Ageing. 2013 Jan;42(1):14-20. ","doi: 10.1093/ageing/afs165. ","Hyde C, Peters J, Bond M, Rogers G, Hoyle M, Anderson R, Jeffreys M, Davis S, Thokala P, Moxham T."," Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer's disease: systematic review and economic model.","In 2007 the National Institute of Health and Clinical Excellence (NICE) restricted the use of acetylcholinesterase inhibitors and memantine. we conducted a health technology assessment (HTA) of the effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of AD to re-consider and up-date the evidence base used to inform the 2007 NICE decision. The systematic review of effectiveness targeted randomised controlled trials. A comprehensive search, including MEDLINE, Embase and the Cochrane Library, was conducted from January 2004 to March 2010. All key review steps were done by two reviewers. Random effects meta-analysis was conducted. The cost-effectiveness was assessed using a cohort-based model with three health states: pre-institutionalised, institutionalised and dead. The perspective was NHS and Personal Social Services and the cost year 2009. confidence about the size and statistical significance of the estimates of effect of galantamine, rivastigmine and memantine improved on function and global impact in particular. Cost-effectiveness also changed. For donepezil, galantamine and rivastigmine, the incremental cost per quality-adjusted life year (QALY) in 2004 was above £50,000; in 2010 the same drugs 'dominated' best supportive care (improved clinical outcome at reduced cost). This was primarily because of changes in the modelled costs of introducing the drugs. For memantine, the cost-effectiveness also improved from a range of £37-53,000 per QALY gained to a base-case of £32,000. there has been a change in the evidence base between 2004 and 2010 consistent with the change in NICE guidance. Further evolution in cost-effectiveness estimates is possible particularly if there are changes in drug prices."," Age Ageing. 2013 Jan;42(1):14-20. ","UK",2013,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine",null,null,null,"Cost-utility"]
[65,"Sköldunger A, Johnell K, Winblad B, Wimo A. Mortality and treatment costs have a great impact on the cost-effectiveness of disease modifying treatment in Alzheimer's disease--a simulation study. Curr Alzheimer Res. 2013 Feb;10(2):207-16.","","Sköldunger A, Johnell K, Winblad B, Wimo A."," Mortality and treatment costs have a great impact on the cost-effectiveness of disease modifying treatment in Alzheimer's disease--a simulation study.","The societal costs of Alzheimer's Disease (AD) are enormous and pose a great challenge for the health and social care in any society. It is of vital importance to develop and identify cost effective treatment. The aim of the study was to present a hypothetical economic model of Disease Modifying Treatment (DMT) in AD. A 20 year Markov cohort model of DMT was constructed, based on Swedish care conditions. States and progression were defined according to the Mini Mental State Examination (MMSE). Epidemiological studies of incidence of dementia, prevalence and costs of Mild Cognitive Impairment (MCI) and AD as well as conversion studies of MCI and demographic statistics were used as inputs in the model. Total costs were 113,797 million SEK for patients treated with DMT vs 88,562 million SEK for untreated patients. The corresponding gained QALYs were 529,945 and 450,307 respectively, giving an incremental cost effectiveness ratio of 293,002 SEK/QALY in the base option. Survival in the model was 8.72 years with DMT and 7.77 years for untreated. With an assumed Willingness to pay (WTP) of 600,000 SEK (about 86,200 US$ and 62,000 ) per gained QALY, the model indicated cost effectiveness with DMT. The sensitivity analysis implied no cost savings with DMT, but most options indicated cost effectiveness vs. the chosen WTP. The main reasons for the higher costs with DMT were the costs of DMT itself and the prolonged survival with DMT. Even if costs increase with DMT, the model indicates cost effectiveness."," Curr Alzheimer Res. 2013 Feb;10(2):207-16.","Sweden",2013,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility"]
[66,"Orrell M, Yates LA, Burns A, Russell I, Woods RT, Hoare Z, Moniz-Cook E, Henderson C, Knapp M, Spector A, Orgeta V. Individual Cognitive Stimulation Therapy for dementia (iCST): study protocol for a randomized controlled trial. Trials. 2012 Sep 22;13():172. ","doi: 10.1186/1745-6215-13-172.","Orrell M, Yates LA, Burns A, Russell I, Woods RT, Hoare Z, Moniz-Cook E, Henderson C, Knapp M, Spector A, Orgeta V."," Individual Cognitive Stimulation Therapy for dementia (iCST): study protocol for a randomized controlled trial.","Improving the quality of care for people with dementia and their carers has become a national priority in many countries. Cognitive Stimulation Therapy (CST) groups can be beneficial in improving cognition and quality of life for people with dementia. The aim of the current study is to develop and evaluate a home-based individual Cognitive Stimulation Therapy (iCST) programme for people with dementia which can be delivered by their family carer. This multi-centre, pragmatic randomised controlled trial (RCT) will compare the effectiveness and cost-effectiveness of iCST for people with dementia with a treatment as usual control group. The intervention consists of iCST sessions delivered by a carer for 30 minutes, 3 times a week over 25 weeks.For people with dementia the primary outcome measures are cognition assessed by the ADAS-Cog, and quality of life assessed by QoL-AD. For carers, quality of life using the SF-12 is the primary outcome measure. Using a 5% significance level, comparison of 306 participants will yield 80% power to detect an effect size of 0.35 for cognition as measured by the ADAS-Cog, and quality of life as measured by the QoL-AD. Quality of life for the carer will be measured using the SF-12. The trial will include a cost-effectiveness analysis from a public sector perspective. The UK Department of Health has recently stressed that improving access to psychological therapies is a national priority, but many people with dementia are unable to access psychological interventions. The development of a home-based individual version of CST will provide an easy to use, widely available therapy package that will be evaluated for effectiveness and cost-effectiveness in a multi centre RCT."," Trials. 2012 Sep 22;13():172. ","UK",2012,"Any dementia","Cognitive therapies",null,null,null,"Cost-utility"]
[67,"Escudero J, Ifeachor E, Zajicek JP, Green C, Shearer J, Pearson S, Alzheimer's Disease Neuroimaging Initiative. Machine learning-based method for personalized and cost-effective detection of Alzheimer's disease. IEEE Trans Biomed Eng. 2013 Jan;60(1):164-8. ","doi: 10.1109/TBME.2012.2212278. ","Escudero J, Ifeachor E, Zajicek JP, Green C, Shearer J, Pearson S, Alzheimer's Disease Neuroimaging Initiative."," Machine learning-based method for personalized and cost-effective detection of Alzheimer's disease.","Diagnosis of Alzheimer's disease (AD) is often difficult, especially early in the disease process at the stage of mild cognitive impairment (MCI). Yet, it is at this stage that treatment is most likely to be effective, so there would be great advantages in improving the diagnosis process. We describe and test a machine learning approach for personalized and cost-effective diagnosis of AD. It uses locally weighted learning to tailor a classifier model to each patient and computes the sequence of biomarkers most informative or cost-effective to diagnose patients. Using ADNI data, we classified AD versus controls and MCI patients who progressed to AD within a year, against those who did not. The approach performed similarly to considering all data at once, while significantly reducing the number (and cost) of the biomarkers needed to achieve a confident diagnosis for each patient. Thus, it may contribute to a personalized and effective detection of AD, and may prove useful in clinical settings."," IEEE Trans Biomed Eng. 2013 Jan;60(1):164-8. ","UK",2013,"Alzheimer’s","Diagnosis",null,null,null,"Unclear"]
[68,"Knapp M, Iemmi V, Romeo R. Dementia care costs and outcomes: a systematic review. Int J Geriatr Psychiatry. 2013 Jun;28(6):551-61. ","doi: 10.1002/gps.3864.","Knapp M, Iemmi V, Romeo R."," Dementia care costs and outcomes: a systematic review.","We reviewed evidence on the cost-effectiveness of prevention, care and treatment strategies in relation to dementia. We performed a systematic review of available literature on economic evaluations of dementia care, searching key databases and websites in medicine, social care and economics. Literature reviews were privileged, and other study designs were included only to fill gaps in the evidence base. Narrative analysis was used to synthesise the results. We identified 56 literature reviews and 29 single studies offering economic evidence on dementia care. There is more cost-effectiveness evidence on pharmacological therapies than other interventions. Acetylcholinesterase inhibitors for mild-to-moderate disease and memantine for moderate-to-severe disease were found to be cost-effective. Regarding non-pharmacological treatments, cognitive stimulation therapy, tailored activity programme and occupational therapy were found to be more cost-effective than usual care. There was some evidence to suggest that respite care in day settings and psychosocial interventions for carers could be cost-effective. Coordinated care management and personal budgets held by carers have also demonstrated cost-effectiveness in some studies. Five barriers to achieving better value for money in dementia care were identified: the scarcity and low methodological quality of available studies, the difficulty of generalising from available evidence, the narrowness of cost measures, a reluctance to implement evidence and the poor coordination of health and social care provision and financing."," Int J Geriatr Psychiatry. 2013 Jun;28(6):551-61. ","International",2013,"Any dementia","Cognitive therapies,Other psychological therapies,Disease management,Any anticholinesterase,Memantine",null,null,null,"Unclear"]
[69,"Bond M, Rogers G, Peters J, Anderson R, Hoyle M, Miners A, Moxham T, Davis S, Thokala P, Wailoo A, Jeffreys M, Hyde C. The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of Technology Appraisal No. 111): a systematic review and economic model. Health Technol Assess. 2012;16(21):1-470. ","doi: 10.3310/hta16210.","Bond M, Rogers G, Peters J, Anderson R, Hoyle M, Miners A, Moxham T, Davis S, Thokala P, Wailoo A, Jeffreys M, Hyde C."," The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of Technology Appraisal No.","Alzheimer’s disease (AD) is the most commonly occurring form of dementia. It is predominantly a disease of later life, affecting 5% of those over 65 in the UK. Review and update guidance to the NHS in England and Wales on the clinical effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine [acetylcholinesterase inhibitors (AChEIs)] and memantine within their licensed indications for the treatment of AD, which was issued in November 2006 (amended September 2007 and August 2009). Electronic databases were searched for systematic reviews and/or metaanalyses, randomised controlled trials (RCTs) and ongoing research in November 2009 and updated in March 2010; this updated search revealed no new includable studies. The databases searched included The Cochrane Library (2009 Issue 4, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials), MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, PsycINFO, EconLit, ISI Web of Science Databases--Science Citation Index, Conference Proceedings Citation Index, and BIOSIS; the Centre for Reviews and Dissemination (CRD) databases--NHS Economic Evaluation Database, Health Technology Assessment, and Database of Abstracts of Reviews of Effects. The clinical effectiveness systematic review was undertaken following the principles published by the NHS CRD. We included RCTs whose population was people with AD. The intervention and comparators depended on disease severity, measured by the Mini Mental State Examination (MMSE). mild AD (MMSE 21-26)--donepezil, galantamine and rivastigmine; moderate AD (MMSE 10-20)--donepezil, galantamine, rivastigmine and memantine; severe AD (MMSE < 10)--memantine. Comparators: mild AD (MMSE 21-26)--placebo or best supportive care (BSC); moderate AD (MMSE 10-20)--donepezil, galantamine, rivastigmine, memantine, placebo or BSC; severe AD (MMSE < 10)--placebo or BSC. The outcomes were clinical, global, functional, behavioural, quality of life, adverse events, costs and cost-effectiveness. Where appropriate, data were pooled using pair-wise meta-analysis, multiple outcome measures, metaregression and mixedtreatment comparisons. The decision model was based broadly on the structure of the three-state Markov model described in the previous technology assessment report, based upon time to institutionalisation, parameterised with updated estimates of effectiveness, costs and utilities. Notwithstanding the uncertainty of our results, we found in the base case that the AChEIs are probably cost saving at a willingness-to-pay (WTP) of £’30,000 per qualityadjusted life-year (QALY) for people with mild-to-moderate AD. For this class of drugs, there is a > 99% probability that the AChEIs are more cost-effective than BSC. These analyses assume that the AChEIs have no effect on survival. For the AChEIs, in people with mild to moderate AD, the probabilistic sensitivity analyses suggested that donepezil is the most cost-effective, with a 28% probability of being the most cost-effective option at a WTP of £’30,000 per QALY (27% at a WTP of £’20,000 per QALY). In the deterministic results, donepezil dominates the other drugs and BSC, which, along with rivastigmine patches, are associated with greater costs and fewer QALYs. Thus, although galantamine has a slightly cheaper total cost than donepezil (£’69,592 vs £’69,624), the slightly greater QALY gains from donepezil (1.616 vs 1.617) are enough for donepezil to dominate galantamine.The probability that memantine is cost-effective in a moderate to severe cohort compared with BSC at a WTP of £’30,000 per QALY is 38% (and 28% at a WTP of £’20,000 per QALY). The deterministic ICER for memantine is £’32,100 per/QALY and the probabilistic ICER is £’36,700 per/QALY. Trials were of 6 months maximum follow-up, lacked reporting of key outcomes, provided no subgroup analyses and used insensitive measures. Searches were limited to English language, The model does not include behavioural symptoms and there is uncertainty about the model structure and parameters. The additional clinical effectiveness evidence identified continues to suggest clinical benefit from the AChEIs in alleviating AD symptoms, although there is debate about the magnitude of the effect. Although there is also new evidence on the effectiveness of memantine, it remains less supportive of this drug’s use than the evidence for AChEIs. The conclusions concerning cost-effectiveness are quite different from the previous assessment. This is because both the changes in effectiveness and costs between drug use and non-drug use underlying the ICERs are very small. This leads to highly uncertain results, which are very sensitive to change. RESEARCH PRIORITIES: RCTs to include mortality, time to institutionalisation and quality of life, powered for subgroup analysis. The National Institute for Health Research Health Technology Assessment programme."," 111): a systematic review and economic model. Health Technol Assess. 2012;16(21):1-470. ","UK",2012,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine",null,null,null,"Cost-utility"]
[70,"Biasutti M, Dufour N, Ferroud C, Dab W, Temime L. Cost-effectiveness of magnetic resonance imaging with a new contrast agent for the early diagnosis of Alzheimer's disease. PLoS One. 2012;7(4):e35559. ","doi: 10.1371/journal.pone.0035559","Biasutti M, Dufour N, Ferroud C, Dab W, Temime L."," Cost-effectiveness of magnetic resonance imaging with a new contrast agent for the early diagnosis of Alzheimer's disease.","Used as contrast agents for brain magnetic resonance imaging (MRI), markers for beta-amyloid deposits might allow early diagnosis of Alzheimer's disease (AD). We evaluated the cost-effectiveness of such a diagnostic test, MRI+CLP (contrastophore-linker-pharmacophore), should it become clinically available. We compared the cost-effectiveness of MRI+CLP to that of standard diagnosis using currently available cognition tests and of standard MRI, and investigated the impact of a hypothetical treatment efficient in early AD. The primary analysis was based on the current French context for 70-year-old patients with Mild Cognitive Impairment (MCI). In alternative \"screen and treat\" scenarios, we analyzed the consequences of systematic screenings of over-60 individuals (either population-wide or restricted to the ApoE4 genotype population). We used a Markov model of AD progression; model parameters, as well as incurred costs and quality-of-life weights in France were taken from the literature. We performed univariate and probabilistic multivariate sensitivity analyses. The base-case preferred strategy was the standard MRI diagnosis strategy. In the primary analysis however, MRI+CLP could become the preferred strategy under a wide array of scenarios involving lower cost and/or higher sensitivity or specificity. By contrast, in the \"screen and treat\" analyses, the probability of MRI+CLP becoming the preferred strategy remained lower than 5%. It is thought that anti-beta-amyloid compounds might halt the development of dementia in early stage patients. This study suggests that, even should such treatments become available, systematically screening the over-60 population for AD would only become cost-effective with highly specific tests able to diagnose early stages of the disease. However, offering a new diagnostic test based on beta-amyloid markers to elderly patients with MCI might prove cost-effective."," PLoS One. 2012;7(4):e35559. ","France",2012,"Alzheimer’s","Diagnosis",null,null,null,"Cost-utility"]
[71,"Pouryamout L, Dams J, Wasem J, Dodel R, Neumann A. Economic evaluation of treatment options in patients with Alzheimer's disease: a systematic review of cost-effectiveness analyses. Drugs. 2012 Apr 16;72(6):789-802. ","doi: 10.2165/11631830-000000000-00000.","Pouryamout L, Dams J, Wasem J, Dodel R, Neumann A."," Economic evaluation of treatment options in patients with Alzheimer's disease: a systematic review of cost-effectiveness analyses.","Alzheimer's disease (AD) is common among the elderly; it is responsible for 60-80% of all dementia cases. AD is characterized by cognitive decline, behavioural and psychological symptoms, and reductions in functioning and independence. Because of its progressive neurodegenerative nature and unknown aetiology, the burden of AD becomes increasingly significant in an aging population. Estimates indicate that 35.6 million people worldwide suffered from AD in 2010. By 2030 and 2050, this figure is predicted to increase to 65.7 million and 115.4 million, respectively. Costs will also rise along with the increase in the number of people diagnosed with AD. In 2010, the worldwide costs associated with dementia were estimated to be $US604 billion. The objective of this study was to conduct a systematic review of current publications dealing with the pharmacoeconomic factors associated with AD medications and to describe the decision-analytic models used to evaluate long-term outcomes. A systematic literature search was performed to identify articles published between 1 January 2007 and 15 July 2010. The search was also based on a previous systematic review, which included literature up to 2007. Articles were included if they were complete and original economic evaluations of AD and if they were comparative in nature. A quality assessment of the included publications was conducted and relevant information was extracted into tables. Seven out of 2067 identified articles were included in this systematic review. Four articles evaluated treatment with donepezil, one with galantamine and two with memantine. The studies were conducted in America, Europe and Asia. Five different groups of medications were compared. The incremental cost-effectiveness ratios (ICERs) for the group of patients treated with donepezil versus no drug treatment ranged from a dominant value to 281, 416.13 euros per quality-adjusted life-year (QALY). Patients treated with donepezil versus placebo showed ICERs with a range from a dominant value (not specified) up to 20, 866.77 euros per QALY. Treatment with memantine in addition to donepezil versus treatment with donepezil alone showed an ICER range from a dominant value to 6818.33 euros per QALY. In comparison with the memantine treatment as an add-on therapy, the ICER of memantine monotherapy versus standard care (without cholinesterase inhibitors [CEIs]) ranged from a dominant value to 63, 087.20 euros per QALY. Finally, the economic evaluation of galantamine in comparison with usual care without any AD drugs showed ICERs ranging from 1894.70 euros to 6953 euros per QALY. The seven identified publications included in this review indicate that treatment with CEIs or memantine seems to be reasonable in terms of clinical effects and costs for patients with AD. Depending on different hypotheses, assumptions and variables (e.g. time horizon, discount rates, initial number of patients in different states, etc.) in the sensitivity analyses, treatment with these drugs seems to be primarily a cost-effective strategy or even a cost-saving strategy. Nevertheless, the results generally are associated with a degree of uncertainty. The comparability of the results from the different economic evaluations is limited because of the different assumptions made."," Drugs. 2012 Apr 16;72(6):789-802. ","International",2012,"Alzheimer’s","Donepezil,Galantamine,Memantine",null,null,null,"Cost-utility"]
[72,"Hartz S, Getsios D, Tao S, Blume S, Maclaine G. Evaluating the cost effectiveness of donepezil in the treatment of Alzheimer's disease in Germany using discrete event simulation. BMC Neurol. 2012 Feb 8;12():2. ","doi: 10.1186/1471-2377-12-2. ","Hartz S, Getsios D, Tao S, Blume S, Maclaine G."," Evaluating the cost effectiveness of donepezil in the treatment of Alzheimer's disease in Germany using discrete event simulation.","Previous cost-effectiveness studies of cholinesterase inhibitors have modeled Alzheimer's disease (AD) progression and treatment effects through single or global severity measures, or progression to \"Full Time Care\". This analysis evaluates the cost-effectiveness of donepezil versus memantine or no treatment in Germany by considering correlated changes in cognition, behavior and function. Rates of change were modeled using trial and registry-based patient level data. A discrete event simulation projected outcomes for three identical patient groups: donepezil 10 mg, memantine 20 mg and no therapy. Patient mix, mortality and costs were developed using Germany-specific sources. Treatment of patients with mild to moderately severe AD with donepezil compared to no treatment was associated with 0.13 QALYs gained per patient, and 0.01 QALYs gained per caregiver and resulted in average savings of €7,007 and €9,893 per patient from the healthcare system and societal perspectives, respectively. In patients with moderate to moderately-severe AD, donepezil compared to memantine resulted in QALY gains averaging 0.01 per patient, and savings averaging €1,960 and €2,825 from the healthcare system and societal perspective, respectively.In probabilistic sensitivity analyses, donepezil dominated no treatment in most replications and memantine in over 70% of the replications. Donepezil leads to savings in 95% of replications versus memantine. Donepezil is highly cost-effective in patients with AD in Germany, leading to improvements in health outcomes and substantial savings compared to no treatment. This holds across a variety of sensitivity analyses."," BMC Neurol. 2012 Feb 8;12():2. ","Germany",2012,"Alzheimer’s","Donepezil,Memantine",null,null,null,"Cost-utility"]
[73,"van de Ven G, Draskovic I, Adang EM, Donders RA, Post A, Zuidema SU, Koopmans RT, Vernooij-Dassen MJ. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial. BMC Geriatr. 2012 Jan 3;12():1. ","doi: 10.1186/1471-2318-12-1.","van de Ven G, Draskovic I, Adang EM, Donders RA, Post A, Zuidema SU, Koopmans RT, Vernooij-Dassen MJ."," Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial.","The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursing-home dementia care. The study is a cluster-randomised controlled trial, with nursing homes grouped in clusters. Studywise minimisation is the allocation method. Nursing homes in the intervention group will receive a dementia-care-mapping intervention, while the control group will receive usual care. The primary outcome measure is resident agitation, to be assessed with the Cohen-Mansfield Agitation Inventory. The secondary outcomes are resident neuropsychiatric symptoms, assessed with the Neuropsychiatric Inventory--Nursing Homes and quality of life, assessed with Qualidem and the EQ-5D. The staff outcomes are stress reactions, job satisfaction and job-stress-related absenteeism, and staff turnover rate, assessed with the Questionnaire about Experience and Assessment of Work, the General Health Questionnaire-12, and the Maastricht Job Satisfaction Scale for Health Care, respectively. We will collect the data from the questionnaires and electronic registration systems. We will employ linear mixed-effect models and cost-effectiveness analyses to evaluate the outcomes. We will use structural equation modelling in the secondary analysis to evaluate the plausibility of a theoretical model regarding the effectiveness of the dementia-care mapping intervention. We will set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementia-care mapping broadly. A novelty of dementia-care mapping is that it offers an integral person-centred approach to dementia care in nursing homes. The major strengths of the study design are the large sample size, the cluster-randomisation, and the one-year follow-up. The generalisability of the implementation strategies may be questionable because the motivation for person-centred care in both the intervention and control nursing homes is above average. The results of this study may be useful in improving the quality of care and are relevant for policymakers. The trial is registered in the Netherlands National Trial Register: NTR2314."," BMC Geriatr. 2012 Jan 3;12():1. ","Netherlands",2012,"Any dementia","Disease management",null,null,null,"Cost-utility"]
[74,"Döpp CM, Graff MJ, Teerenstra S, Adang E, Nijhuis-van der Sanden RW, Olderikkert MG, Vernooij-Dassen MJ. A new combined strategy to implement a community occupational therapy intervention: designing a cluster randomized controlled trial. BMC Geriatr. 2011 Mar 30;11():13. ","doi: 10.1186/1471-2318-11-13. ","Döpp CM, Graff MJ, Teerenstra S, Adang E, Nijhuis-van der Sanden RW, Olderikkert MG, Vernooij-Dassen MJ."," A new combined strategy to implement a community occupational therapy intervention: designing a cluster randomized controlled trial.","Even effective interventions for people with dementia and their caregivers require specific implementation efforts. A pilot study showed that the highly effective community occupational therapy in dementia (COTiD) program was not implemented optimally due to various barriers. To decrease these barriers and make implementation of the program more effective a combined implementation (CI) strategy was developed. In our study we will compare the effectiveness of this CI strategy with the usual educational (ED) strategy. In this cluster randomized, single-blinded, controlled trial, each cluster consists of at least two occupational therapists, a manager, and a physician working at Dutch healthcare organizations that deliver community occupational therapy. Forty-five clusters, stratified by healthcare setting (nursing home, hospital, mental health service), have been allocated randomly to either the intervention group (CI strategy) or the control group (ED strategy). The study population consists of the professionals included in each cluster and community-dwelling people with dementia and their caregivers. The primary outcome measures are the use of community OT, the adherence of OTs to the COTiD program, and the cost effectiveness of implementing the COTiD program in outpatient care. Secondary outcome measures are patient and caregiver outcomes and knowledge of managers, physicians and OTs about the COTiD program. Implementation research is fairly new in the field of occupational therapy, making this a unique study. This study does not only evaluate the effects of the CI-strategy on professionals, but also the effects of professionals' degree of implementation on client and caregiver outcomes. NCT01117285."," BMC Geriatr. 2011 Mar 30;11():13. ","Netherlands",2011,"Any dementia","Occupational therapy",null,null,null,"Unclear"]
[75,"Chenoweth L, King M, Luscombe G, Forbes I, Jeon YH, Parbury JS, Brodaty H, Fleming R, Haas M. Study protocol of a randomised controlled group trial of client and care outcomes in the residential dementia care setting. Worldviews Evid Based Nurs. 2011 Sep;8(3):153-65. ","doi: 10.1111/j.1741-6787.2010.00204.x.","Chenoweth L, King M, Luscombe G, Forbes I, Jeon YH, Parbury JS, Brodaty H, Fleming R, Haas M."," Study protocol of a randomised controlled group trial of client and care outcomes in the residential dementia care setting.","Literature suggests that quality of life (QOL), quality of care (QOC) and Behavioural and Psychological Symptoms of Dementia (BPSD) can be improved by relatively simple and inexpensive person-centred approaches to nursing care practices (PCC) and modifications to physical environment (PCE). Most research on this topic is observational and few randomised controlled trials have included an economic evaluation of PCC and PCE together. The PerCEN study aims to confirm the value of evidence-based nursing by evaluating the efficacy and cost effectiveness of implementing PCC and PCE in residential dementia care services. This article describes the PerCEN study protocol (ANZCTR 12608000095369). The 3-year study commenced in 2009 in 38 eligible government-accredited residential dementia care homes in New South Wales, Australia. Study participants include 605 consented residents over 60 years of age with dementia and 380 consenting permanent direct-care staff. The study employs a factorial, group-randomised, cohort design with stratification to evaluate the main effects of PCC and PCE and their joint effects (PCC + PCE), compared with Usual Care (UC) and Usual Environment (UE) on QOL, QOC and BPSD in dementia. The primary outcomes analysis will use a mixed-model analysis of covariance to determine the effects of PCC and PCE on resident QOL and BPSD, and QOC, adjusting for stratification and other potential confounders. The incremental cost of providing PCE and PCC over UC and UE will be calculated; costs and outcomes will be presented as a cost-consequence analysis and cost-effectiveness ratios will be estimated as a cost per unit change in resident QOL and BPSD. This cluster-randomised trial will rigorously test Kitwood's Social-Psychological Theory of Personhood in Dementia (Kitwood & Bredin 1992). The results will provide timely and solid evidence that can inform policy and nursing practice development in improving the person's QOL and QOC, and reducing BPSD."," Worldviews Evid Based Nurs. 2011 Sep;8(3):153-65. ","Australia",2011,"Any dementia","Disease management",null,null,null,"Cost-effectiveness"]
[76,"Jutkowitz E, Gitlin LN, Pizzi LT. Evaluating willingness-to-pay thresholds for dementia caregiving interventions: application to the tailored activity program. Value Health. 2010 Sep-Oct;13(6):720-5. ","doi: 10.1111/j.1524-4733.2010.00739.x. ","Jutkowitz E, Gitlin LN, Pizzi LT."," Evaluating willingness-to-pay thresholds for dementia caregiving interventions: application to the tailored activity program.","The study aims to apply willingness-to-pay (WTP) values derived from the literature to inform decision-makers of the cost-effectiveness of the Tailored Activity Program (TAP), an intervention proven to reduce caregiver burden. TAP and other caregiver interventions employ an individual perspective and non-quality-adjusted life-year (QALY) outcome measure where the primary objective is to determine caregiver burden from an individual perspective. Therefore, standard cost/QALY thresholds are not appropriate. To identify relevant WTP values, we searched for studies that: 1) were published in the past 5 years and used contingent valuation methodology to identify WTP; 2) assessed WTP for a dementia-related intervention requiring out-of-pocket expenditure; and 3) asked caregivers their WTP for an outcome related to reducing caregiver burden. Three studies were identified utilizing four WTP values. We also assessed potential financial savings that caregivers could achieve from purchasing TAP. To assess the probability of TAP being cost-effective, we built a Monte Carlo simulation to test the four WTP values applied to two TAP outcome measures: reduction in caregiver hours \"on duty;\" and \"doing things.\"   For outcome measure \"on duty,\" WTP varied between $1.06/hour and $4.58/hour. For outcome measure \"doing things,\" WTP varied between $2.21/hour and $9.57/hour. Applying the four identified WTP values from the literature to TAP outcomes resulted in TAP cost-effectiveness varying between 50% and 80% for both outcome measures. When WTP data are not collected prospectively or conventional metrics cannot be applied, retrospectively assessing literature-derived WTP may be acceptable for informing decision-makers of potential cost-effectiveness of a proven program. Application of WTP to TAP shows potential cost-effectiveness that can be expected under the tested WTP scenarios."," Value Health. 2010 Sep-Oct;13(6):720-5. ","USA",2010,"Any dementia","Support",null,null,null,"Cost-utility"]
[77,"Aguirre E, Spector A, Hoe J, Russell IT, Knapp M, Woods RT, Orrell M. Maintenance Cognitive Stimulation Therapy (CST) for dementia: a single-blind, multi-centre, randomized controlled trial of Maintenance CST vs. CST for dementia. Trials. 2010 Apr 28;11():46. ","doi: 10.1186/1745-6215-11-46. ","Aguirre E, Spector A, Hoe J, Russell IT, Knapp M, Woods RT, Orrell M."," Maintenance Cognitive Stimulation Therapy (CST) for dementia: a single-blind, multi-centre, randomized controlled trial of Maintenance CST vs.","Psychological treatments for dementia are widely used in the UK and internationally, but only rarely have they been standardised, adequately evaluated or systematically implemented. There is increasing recognition that psychosocial interventions may have similar levels of effectiveness to medication, and both can be used in combination. Cognitive Stimulation Therapy (CST) is a 7-week cognitive-based approach for dementia that has been shown to be beneficial for cognition and quality of life and is cost-effective, but there is less conclusive evidence for the effects of CST over an extended period. This multi-centre, pragmatic randomised controlled trial (RCT) to assess the effectiveness and cost-effectiveness of Maintenance CST groups for dementia compares a intervention group who receive CST for 7 weeks followed by the Maintenance CST programme once a week for 24 weeks with the control group who receive CST for 7 weeks, followed by treatment as usual for 24 weeks.The primary outcome measures are quality of life of people with dementia assessed by the QoL-AD and cognition assessed by the ADAS-Cog. Secondary outcomes include the person with dementia's mood, behaviour, activities of daily living, ability to communicate and costs; as well as caregiver health-related quality of life. Using a 5% significance level, comparison of 230 participants will yield 80% power to detect a standardised difference of 0.39 on the ADAS-Cog between the groups. The trial includes a cost-effectiveness analysis from a public sector perspective. A pilot study of longer-term Maintenance CST, offering 16 weekly sessions of maintenance following the initial CST programme, previously found a significant improvement in cognitive function (MMSE) for those on the intervention group. The study identified the need for a large-scale, multi-centre RCT to define the potential longer-term benefits of continuing the therapy. This study aims to provide definitive evidence of the potential efficacy of maintenance CST and establish how far the long-term benefits can be compared with antidementia drugs such as cholinesterase inhibitors."," CST for dementia. Trials. 2010 Apr 28;11():46. ","UK",2010,"Any dementia","Cognitive therapies",null,null,null,"Unclear"]
[78,"Wong CL, Bansback N, Lee PE, Anis AH. Cost-effectiveness: cholinesterase inhibitors and memantine in vascular dementia. Can J Neurol Sci. 2009 Nov;36(6):735-9. ","","Wong CL, Bansback N, Lee PE, Anis AH."," Cost-effectiveness: cholinesterase inhibitors and memantine in vascular dementia.","Several randomized controlled trials of cholinesterase inhibitors and memantine in mild to moderate vascular dementia have demonstrated the efficacy of these treatments. However, given these drugs incur considerable cost, the economic argument for their use is less clear. To determine the incremental cost-effectiveness of cholinesterase inhibitors and memantine for mild to moderate vascular dementia. A decision analysis model using a 24-28 week time horizon was developed. Outcomes of cholinesterase inhibitors and memantine and probabilities of adverse events were extracted from a systematic review. Costs of adverse events, medications, and physician visits were obtained from local estimates. Robustness was tested with probabilistic sensitivity analysis using a Monte Carlo simulation. Donepezil 5 mg daily, donepezil 10 mg daily, galantamine 16-24 mg daily, rivastigmine flexible dosing up to 6 mg twice daily, or memantine 10 mg twice daily versus standard care. Incremental cost-effectiveness ratio (ICER) expressed as cost per unit decrease in the Alzheimer's Disease Assessment Scale-cognitive (ADAS-cog) subscale. Donepezil 10 mg daily was found to be the most cost-effective treatment with an ICER of $400.64 (95%CI, $281.10-$596.35) per unit decline in the ADAS-cog subscale. All other treatments were dominated by donepezil 10 mg, that is, more costly and less effective. From a societal perspective, treatment with cholinesterase inhibitors or memantine was more effective but also more costly than standard care for mild to moderate vascular dementia. The donepezil 10 mg strategy was the most cost-effective and also dominated the other alternatives."," Can J Neurol Sci. 2009 Nov;36(6):735-9. ","Canada",2009,"Vascular dementia","Donepezil,Galantamine,Memantine,Rivastigmine",null,null,null,"Cost-effectiveness"]
[79,"McKeage K. Memantine: a review of its use in moderate to severe Alzheimer's disease. CNS Drugs. 2009 Oct;23(10):881-97. ","doi: 10.2165/11201020-000000000-00000. ","McKeage K."," Memantine: a review of its use in moderate to severe Alzheimer's disease.","Memantine is an uncompetitive, moderate-affinity NMDA receptor antagonist that is indicated for the treatment of moderate to severe Alzheimer's disease. In well designed trials in patients with moderate to severe Alzheimer's disease, oral memantine monotherapy improved outcomes in the area of functional ability more than placebo in one trial, but in a second trial, treatment differences did not reach significance. Memantine has a distinct mode of action compared with that of acetylcholinesterase (AChE) inhibitors, and in a well designed study, combination therapy with memantine plus donepezil improved outcomes more than donepezil plus placebo in all four domains (function, cognition, behaviour and global change). Memantine is generally well tolerated, with adverse events occurring with a similar incidence to that reported with placebo. In modelled cost-effectiveness analyses, memantine was dominant to no therapy in regard to cost per quality-adjusted life-year (QALY) gained, and the combination of memantine plus donepezil was dominant to donepezil therapy alone in regard to QALYs gained when treatment periods exceeded 1 year in patients with moderate to severe disease. Thus, in the management of patients with moderate to severe Alzheimer's disease, memantine provides an effective treatment option. To date, clinical trial support is greater for memantine use in combination with an AChE inhibitor, while more data are needed to confirm its efficacy as monotherapy."," CNS Drugs. 2009 Oct;23(10):881-97. ","International",2009,"Alzheimer’s","Donepezil,Memantine",null,null,null,"Cost-utility"]
[80,"Woods RT, Bruce E, Edwards RT, Hounsome B, Keady J, Moniz-Cook ED, Orrell M, Russell IT. Reminiscence groups for people with dementia and their family carers: pragmatic eight-centre randomised trial of joint reminiscence and maintenance versus usual treatment: a protocol. Trials. 2009 Jul 30;10():64. ","doi: 10.1186/1745-6215-10-64.","Woods RT, Bruce E, Edwards RT, Hounsome B, Keady J, Moniz-Cook ED, Orrell M, Russell IT."," Reminiscence groups for people with dementia and their family carers: pragmatic eight-centre randomised trial of joint reminiscence and maintenance versus usual treatment: a protocol.","The growing number of people with dementia, and the increasing cost of care, provides a major incentive to develop and test methods of supporting them in the community for longer. Most attention has been given to pharmacological interventions, but there is increasing recognition that psychosocial interventions may be equally effective, even preferable where medication has negative side-effects. Reminiscence groups, run by professionals and volunteers, which use photographs, recordings and other objects to trigger personal memories are probably the most popular therapeutic approach to working with people with dementia, but there is little evidence for their effectiveness and cost-effectiveness. The recent inclusion of family carers in groups with people with dementia, notably in our own pilot studies, has generated informal evidence that this joint approach improves relationships between people with dementia and their carers, and benefits both. This multi-centre, pragmatic randomised controlled trial (RCT) to assess the effectiveness and cost-effectiveness of joint reminiscence groups for people with dementia and their family care-givers has two parallel arms--an intervention group and a control group who receive care as usual. The intervention consists of joint reminiscence groups held weekly for twelve consecutive weeks, followed by monthly maintenance sessions for a further seven months.The primary outcome measures are the quality of life of people with dementia, as assessed by QoL-AD, and their care-givers' mental health as assessed by the GHQ-28. Secondary outcomes include: the autobiographical memories of people with dementia; the quality of the relationship between them and their care-givers; and the levels of depression and anxiety felt by them and their care-giver. Using a 5% significance level, comparison of 200 pairs attending joint reminiscence groups with 200 pairs receiving usual treatment will yield 80% power to detect a standardised difference of 0.38 in the QoL-AD rated by the person with dementia and 0.28 in the GHQ-28 or carer-rated QoL-AD. The trial will include a cost-effectiveness analysis from a public sector perspective. Our Cochrane review (2005) on reminiscence therapy for people with dementia did not identify any rigorous trials or economic analyses in this field. ISRCTN42430123."," Trials. 2009 Jul 30;10():64. ","UK",2009,"Any dementia","Other psychological therapies",null,null,null,"Unclear"]
[81,"Gustavsson A, Van Der Putt R, Jönsson L, McShane R. Economic evaluation of cholinesterase inhibitor therapy for dementia: comparison of Alzheimer's disease and Dementia with Lewy bodies. Int J Geriatr Psychiatry. 2009 Oct;24(10):1072-8. ","doi: 10.1002/gps.2223. ","Gustavsson A, Van Der Putt R, Jönsson L, McShane R."," Economic evaluation of cholinesterase inhibitor therapy for dementia: comparison of Alzheimer's disease and Dementia with Lewy bodies.","To assess the cost effectiveness of cholinesterase inhibitor (ChEI) treatment in patients with Alzheimer's disease (AD) and Dementia with Lewy bodies (DLB). We used 4-month open label follow-up data from routine memory clinic patients. There were 852 patients with AD and 112 with DLB. We applied three predictive models to estimate clinical and economic outcomes at five years, comparing AD and DLB patients with hypothetical untreated controls. The mean improvement in MMSE in 852 AD patients was 0.57 (SD 3.4) at 4 months, and in the subgroup with baseline MMSE of 10-20 (moderate) was 1.6 (SD 3.7). Overall, the 112 DLB patients improved by 1.4 (SD 3.7). DLB patients with an MMSE 10-20 improved by 3.1 (SD 4.5) points. These efficacy data were input into the SHTAC, microsimulation and Markov models and produced estimated costs per QALY gained (CQG) for all AD of pound194,066, pound67,904 and pound123,935 respectively. In comparison, the CQGs for all DLB were pound46,794, pound2,706 and pound35,922. For the moderate subgroups only the SHTAC and microsimulation models were applicable. These gave CQG estimates for moderate AD of pound39,664 and cost saving respectively. For moderate DLB, both estimates were cost saving. The cost per QALY gained of cholinesterase treatment of all patients with DLB (including those with MMSE outside the 10-20 range) is comparable to that of patients with moderate AD, and is probably cost saving."," Int J Geriatr Psychiatry. 2009 Oct;24(10):1072-8. ","UK",2009,"Alzheimer’s,Lewy body dementia","Any anticholinesterase",null,null,null,"Cost-utility"]
[82,"Wolfs CA, Dirksen CD, Kessels A, Severens JL, Verhey FR. Economic evaluation of an integrated diagnostic approach for psychogeriatric patients: results of a randomized controlled trial. Arch Gen Psychiatry. 2009 Mar;66(3):313-23. ","doi: 10.1001/archgenpsychiatry.2008.544.","Wolfs CA, Dirksen CD, Kessels A, Severens JL, Verhey FR."," Economic evaluation of an integrated diagnostic approach for psychogeriatric patients: results of a randomized controlled trial.","Because of the increasing number of elderly people with dementia, the costs of dementia and dementia care are expected to grow rapidly in the coming decades. Cost-effectiveness results are relevant for decision making about new strategies in dementia care. To evaluate the cost-effectiveness of an integrated multidisciplinary diagnostic facility for diagnosing dementia in ambulatory psychogeriatric patients. Randomized controlled trial with an economic evaluation component. The Maastricht Evaluation of a Diagnostic Intervention for Cognitively Impaired Elderly, Maastricht University Hospital, Maastricht, the Netherlands. A total of 137 patients who received care in the multidisciplinary diagnostic facility and 93 who received usual care. Quality-adjusted life-years (QALYs) as the main outcome measure and cognition and behavioral problems as secondary outcome measures. Compared with patients receiving usual care, patients who visited the diagnostic facility gained a mean 0.05 QALY at the extra cost of euro65. The incremental cost per QALY amounted to euro1267. This point estimate lies beneath commonly accepted thresholds and is within an acceptable range of uncertainty. With regard to the secondary analyses, cost-effectiveness results showed a substantial amount of uncertainty and were therefore indecisive. On the basis of the main cost-per-QALY analysis, the use of the integrated multidisciplinary diagnostic facility is cost-effective for the diagnosis and management of dementia in ambulatory patients."," Arch Gen Psychiatry. 2009 Mar;66(3):313-23. ","Netherlands",2009,"Any dementia","Diagnosis",null,null,null,"Cost-utility"]
[83,"López-Bastida J, Hart W, García-Pérez L, Linertová R. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease. J Alzheimers Dis. 2009;16(2):399-407. ","doi: 10.3233/JAD-2009-0965.","López-Bastida J, Hart W, García-Pérez L, Linertová R."," Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease.","Available treatments for Alzheimer's disease (AD) need to be evaluated in order to determine whether the clinical benefits justify their additional costs. This study evaluated the cost-effectiveness of donepezil treatment compared with no-drug treatment of mild and moderate AD from the perspective of society and the health care system in Spain. A Markov model was designed to simulate the natural history of a cohort of patients with mild and moderate AD. Monthly transition probabilities were estimated from the international literature and donepezil clinical trials. Direct medical and non-medical costs and utilities were derived from Spanish studies. Local data on tolerance and medication withdrawal rates were incorporated into the model. Incremental cost-effectiveness ratios for a range of realistic treatment options were calculated. A probabilistic sensitivity analysis was carried out using a Monte Carlo approach with 10,000 iterations. In the baseline scenario (24 months, patients initially with mild AD) incremental cost-effectiveness for direct medical costs was 20,353 euro/QALY. When all costs were taken into account, donepezil treatment was the dominant strategy. Incremental cost-effectiveness ratios vary according to the selected perspective. For the baseline scenario, donepezil treatment is cost-effective with a probability of 95% for a threshold efficiency of 25,000 euro/QALY."," J Alzheimers Dis. 2009;16(2):399-407. ","Spain",2009,"Alzheimer’s","Donepezil",null,null,null,"Cost-utility"]
[84,"Banerjee S, Wittenberg R. Clinical and cost effectiveness of services for early diagnosis and intervention in dementia. Int J Geriatr Psychiatry. 2009 Jul;24(7):748-54. ","doi: 10.1002/gps.2191.","Banerjee S, Wittenberg R."," Clinical and cost effectiveness of services for early diagnosis and intervention in dementia.","This paper analyses the costs and benefits of commissioning memory services for early diagnosis and intervention for dementia. A model was developed to examine potential public and private savings associated with delayed admissions to care homes in England as a result of the commissioning of memory services. The new services would cost around pound sterling 220 million extra per year nationally in England. The estimated savings if 10% of care home admissions were prevented would by year 10 be around pound sterling 120 million in public expenditure (social care) and pound sterling 125 million in private expenditure (service users and their families), a total of pound sterling 245 million. Under a 20% reduction, the annual cost would within around 6 years be offset by the savings to public funds alone. In 10 years all people with dementia will have had the chance to be seen by the new services. A gain of between 0.01 and 0.02 QALYs per person year would be sufficient to render the service cost-effective (in terms of positive net present value). These relatively small improvements seem very likely to be achievable. These analyses suggest that the service need only achieve a modest increase in average quality of life of people with dementia, plus a 10% diversion of people with dementia from residential care, to be cost-effective. The net increase in public expenditure would then, on the assumptions discussed and from a societal perspective, be justified by the expected benefits. This modelling presents for debate support for the development of nationwide services for the early identification and treatment of dementia in terms of quality of life and overall cost-effectiveness."," Int J Geriatr Psychiatry. 2009 Jul;24(7):748-54. ","UK",2009,"Any dementia","Diagnosis",null,null,null,"Cost-utility"]
[85,"Wilson E, Thalanany M, Shepstone L, Charlesworth G, Poland F, Harvey I, Price D, Reynolds S, Mugford M. Befriending carers of people with dementia: a cost utility analysis. Int J Geriatr Psychiatry. 2009 Jun;24(6):610-23. ","doi: 10.1002/gps.2164.","Wilson E, Thalanany M, Shepstone L, Charlesworth G, Poland F, Harvey I, Price D, Reynolds S, Mugford M."," Befriending carers of people with dementia: a cost utility analysis.","There is very little evidence on the cost-effectiveness of social care interventions for people with dementia or their carers. The BEfriending and Costs of CAring trial (BECCA, ISRCTN08130075) aimed to establish whether a structured befriending service improved the quality of life of carers of people with dementia, and at what cost. We performed an economic evaluation alongside a single blind, randomised controlled trial in a community setting of 236 carers of people with a primary progressive dementia. The intervention was contact with a Befriender Facilitator (BF), and offer of match with a trained lay volunteer befriender compared with no BF contact. Main outcome measures were health and social care, voluntary sector, and family care costs and quality adjusted life years (QALYs) in carers over 15 months. Mean QALYs per carer over 15 months were 0.017 higher in the intervention group compared with control (95%CI: -0.051, 0.083). Mean costs from a societal perspective were pound 1,813 higher (- pound 11,312, pound 14,984). The point estimate Incremental Cost Effectiveness Ratio (ICER) is thus pound 105,954 per incremental QALY gained. Probabilistic sensitivity analysis suggests a 42.2% probability that the ICER is below pound 30,000 per QALY. Inclusion of dementia patient QALYs reduces the ICER to pound 28,848 (51.4% probability below pound 30,000). Befriending leads to a non-significant trend towards improved carer quality of life, and there is a non-significant trend towards higher costs for all sectors. It is unlikely that befriending is a cost-effective intervention from the point of view of society."," Int J Geriatr Psychiatry. 2009 Jun;24(6):610-23. ","UK",2009,"Any dementia","Support",null,null,null,"Cost-utility"]
[86,"Soejono CH. The impact of 'comprehensive geriatric assessment (CGA)' implementation on the effectiveness and cost (CEA) of healthcare in an acute geriatric ward. Acta Med Indones. 2008 Jan;40(1):3-10. ","","Soejono CH."," The impact of 'comprehensive geriatric assessment (CGA)' implementation on the effectiveness and cost (CEA) of healthcare in an acute geriatric ward.","To investigate the cost effectiveness of CGA in an acute geriatric ward. a non-randomized controlled trial was carried out at Dr. Cipto Mangunkusumo General Hospital from January to December 2005. The inclusion criteria were elderly patients with geriatric syndrome. Exclusion criteria were advanced malignancy, APACHE II score > 34,in-hospital mortality in the first 24 hours, move to another ward before completing CGA management, the presence of dementia. After patients were allocated into CGA and non-CGA group, effectiveness was assessed using ADL/WHO Unescap score, days of hospitalization, proportion of re-hospitalization, survival, quality of life score (EQ5D),patients and nurses satisfaction score. Cost effectiveness analysis was done using TreeAge-Pro 2004 software program. the length of hospitalization was shorter in the CGA group than in non-CGA group (10.99 [0.79] days vs.20.16 [2.62] days; p=0.00). At the end of treatment, mean of ADL score changes was significantly higher in CGA group than non-CGA group. Mean of WHO-Unescap score changes in CGA group was higher than non-CGA group (0.71[0.04]vs 0.61 [0.04]; p=0.09). EQ5D-VAS score was also higher in CGA group (0.79[0,01] vs 0.75[0.01]; p=0,01). Survival proportion in CGA group was lower than non-CGA group(80.37% vs 86.92%; p>0.05). Rehospitalization proportion was higher in non-CGA group than in CGA group (21.5%vs 11.21%; p 0.04). Patient's satisfaction level was higher in CGA group (193.38 [1.25] vs 177.47 [3.04]; p=0.00).Nurse satisfaction level was also higher in CGA group than non-CGA group but not statistically significant (225.06[7.08] vs 220.06[8.26]; p=0.65).Mean of healthcare cost in non-CGA group was higher than in CGA group (Rp. 9,746,426.00 [1,180,331] vs Rp 4,760,965.00 [338,089]). Cost effectiveness analysis indicated that CGA was superior to conventional approach because for each point score of QALD's, total cost was lower in geriatric acute care unit than in conventional ward(Rp 418,199.00 vs Rp 628,695.00). Moreover, QALD's in CGA group was better than in non-CGA group (24.1 vs 22.8; p= 0.03). the CGA approach is more cost effective compared to conventional approach. Quality adjusted life days are better in CGA group than in non-CGA group although survival is not statistically different. In CGA group, length of hospitalization was shorter, functional status and patient satisfaction is better in general. Working satisfaction of nurses in CGA group was not lower than in non CGA group."," Acta Med Indones. 2008 Jan;40(1):3-10. ","Indonesia",2008,"Any dementia","Disease management",null,null,null,"Cost-utility"]
[87,"Kirbach S, Simpson K, Nietert PJ, Mintzer J. A markov model of the cost effectiveness of olanzapine treatment for agitation and psychosis in Alzheimer's disease. Clin Drug Investig. 2008;28(5):291-303.","","Kirbach S, Simpson K, Nietert PJ, Mintzer J."," A markov model of the cost effectiveness of olanzapine treatment for agitation and psychosis in Alzheimer's disease.","Antipsychotics have long been used to treat agitation and psychosis related to Alzheimer's disease, but in a limited fashion because of troubling adverse effects. The new atypical antipsychotics are thought to be at least as effective as first-generation drugs and to cause fewer adverse effects. These drugs, however, are currently not US FDA-approved for use among elderly demented subjects due to a slight increase in the risk of death and serious cardiovascular events within this population. However, their favourable adverse effect profile has led many physicians to prescribe these drugs as first-line therapy for behaviourally disturbed patients with Alzheimer's disease. Clinical trials to evaluate the use of atypical antipsychotics have produced varying results, and clarity has not yet been achieved. Thus, a quantitative summary of the risks and benefits may help inform complex decisions that must be made in this area. In this study we set out to compare the expected costs and outcomes for a community-dwelling cohort of patients with Alzheimer's disease with agitation and/or psychosis who are (a) untreated, or (b) treated with olanzapine. We constructed a Markov state-transition model using the best published data from several sources for Alzheimer's disease patient progression and treatment. This model allowed us to compare the expected costs and outcomes associated with olanzapine treatment compared with no treatment for a synthetic cohort of US adults aged > or =65 years. The model cycles every 6 months and continues until all patients die from Alzheimer's disease progression or from co-morbid conditions. Outcome estimates included the incremental cost-effectiveness ratio (ICER) and cost per quality-adjusted life-year (QALY) gained. The robustness of the estimates was examined by sensitivity analyses of key parameters, including cost of care, olanzapine effectiveness and Alzheimer's disease progression rates. Results indicated that olanzapine was a cost-effective treatment for agitation and psychosis related to Alzheimer's disease when compared with no treatment (ICER <$US50,000). In addition, sensitivity analyses demonstrated that olanzapine remained cost effective despite multiple variations of several parameters, both alone and concurrently. Olanzapine treatment for agitation and psychosis related to Alzheimer's disease is cost effective when compared with no treatment. Further analysis should be performed as atypical antipsychotics become generic, as more information on health utilities in the Alzheimer's disease population becomes available, and to compare atypical antipsychotics with first-generation antipsychotics."," Clin Drug Investig. 2008;28(5):291-303.","USA",2008,"Alzheimer’s","Antipsychotics",null,null,null,"Cost-utility"]
[88,"Charlesworth G, Shepstone L, Wilson E, Thalanany M, Mugford M, Poland F. Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial. Health Technol Assess. 2008 Mar;12(4):iii, v-ix, 1-78.","","Charlesworth G, Shepstone L, Wilson E, Thalanany M, Mugford M, Poland F."," Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial.","To determine whether a social support intervention (access to an employed befriending facilitator in addition to usual care) is effective compared with usual care alone. Also to document direct and indirect costs, and establish incremental cost-effectiveness. The Befriending and Costs of Caring (BECCA) trial was a cost-effectiveness randomised controlled trial. Data on well-being and resource use were collected through interviews with participants at baseline and at 6, 15 and 24 months. This research was carried out in the English counties of Norfolk and Suffolk, and the London Borough of Havering. It was a community-based study. Participants were family carers who were cohabiting with, or providing at least 20 hours' care per week for, a community-dwelling relative with a primary progressive dementia. The intervention was 'access to a befriender facilitator' (BF). BFs, based with charitable/voluntary-sector organisations, were responsible for local befriending schemes, including recruitment, screening, training and ongoing support of befriending volunteers, and for matching carers with befrienders. The role of befrienders was to provide emotional support for carers. The target duration for befriending relationships was 6 months or more. Depression was measured by the Hospital Anxiety and Depression Scale (HADS) at 15 months postrandomisation. The health-related quality of life scale EQ-5D (EuroQol 5 Dimensions) was used to derive utilities for the calculation of quality-adjusted life-years (QALYs). A total of 236 carers were randomised into the trial (116 intervention; 120 control). At final follow-up, 190 carers (93 intervention; 97 control) were still involved in the trial (19% attrition). There was no evidence of effectiveness or cost-effectiveness from the primary analyses on the intention-to-treat population. The mean incremental cost per incremental QALY gained was in excess of 100,000 pounds, with only a 42.2% probability of being below 30,000 pounds per QALY gained. Where care-recipient QALYs were included, mean incremental cost per incremental QALY gained was 26,848 pounds, with a 51.4% probability of being below 30,000 pounds per QALY gained. Only 60 carers (52%) took up the offer of being matched with a trained lay befriender, and of these only 37 (32%) were befriended for 6 months or more. A subgroup analysis of controls versus those befriended for 6 months or more found a reduction in HADS-depression scores that approached statistical significance (95% CI -0.09 to 2.84). 'Access to a befriender facilitator' is neither an effective nor a cost-effective intervention in the support of carers of people with dementia, although there is a suggestion of cost-effectiveness for the care dyad (carer and care recipient). In common with many services for carers of people with dementia, uptake of befriending services was not high. However, the small number of carers who engaged with befrienders for 6 months or more reported a reduction in scores on HADS depression that approached statistical significance compared with controls (95% CI -0.09 to 2.84). While providing only weak evidence of any beneficial effect, further research into befriending interventions for carers is warranted."," Health Technol Assess. 2008 Mar;12(4):iii, v-ix, 1-78.","UK",2008,"Any dementia","Support",null,null,null,"Cost-utility"]
[89,"Joling KJ, van Hout HP, Scheltens P, Vernooij-Dassen M, van den Berg B, Bosmans J, Gillissen F, Mittelman M, van Marwijk HW. (Cost)-effectiveness of family meetings on indicated prevention of anxiety and depressive symptoms and disorders of primary family caregivers of patients with dementia: design of a randomized controlled trial. BMC Geriatr. 2008 Jan 21;8():2. ","doi: 10.1186/1471-2318-8-2","Joling KJ, van Hout HP, Scheltens P, Vernooij-Dassen M, van den Berg B, Bosmans J, Gillissen F, Mittelman M, van Marwijk HW."," (Cost)-effectiveness of family meetings on indicated prevention of anxiety and depressive symptoms and disorders of primary family caregivers of patients with dementia: design of a randomized controlled trial.","Dementia is a major public health problem with enormous costs to society and major consequences for both patients and their relatives. Family members of persons with dementia provide much of the care for older adults with dementia in the community. Caring for a demented relative is not easy and fraught with emotional strain, distress, and physical exhaustion. Family caregivers of dementia patients have an extremely high risk developing affective disorders such as major depression and anxiety disorder. Family meetings appear to be among the most powerful psychosocial interventions to reduce depression in caregivers. An American landmark study reported substantial beneficial effects of a multifaceted intervention where family meetings had a central place on depression in family caregivers as well as on delay of institutionalization of patients. These effects were not replicated in other countries yet. We perform the first trial comparing only structured family meetings with significant others versus usual care among primary family caregivers of community dwelling demented patients and measure the effectiveness on both depression and anxiety in the primary caregiver, both on disorder and symptom levels. In this randomized controlled trial effectiveness as well as cost-effectiveness of family meetings is evaluated. The intervention group receives four family meetings with family and close friends of the primary family caregiver of a community dwelling patient with a clinical diagnosis of dementia. Dyads of patients and their primary caregiver are followed up to one year after baseline assessment. The main outcome measures are the incidence of anxiety and depressive disorders assessed with the Mini-International Neuropsychiatric Interview (MINI) and the severity of anxiety and depressive symptoms in caregivers is measured by validated self report instruments: the Centre for Epidemiologic Studies Depression Scale (CES-D) for depression and the anxiety scales of the Hospital Anxiety and Depression scales (HADS) for anxiety. The economic evaluation is performed from a societal perspective. By evaluating the effectiveness of only structured family meetings organized in the Netherlands, this study will contribute to the existing literature about the value of psychosocial interventions for dementia caregivers. Dutch Trial Registry ISRCTN90163486."," BMC Geriatr. 2008 Jan 21;8():2. ","Netherlands",2008,"Any dementia","Support",null,null,null,"Unclear"]
[90,"Nichols LO, Chang C, Lummus A, Burns R, Martindale-Adams J, Graney MJ, Coon DW, Czaja S, Resources for Enhancing Alzheimer's Caregivers Health II Investigators. The cost-effectiveness of a behavior intervention with caregivers of patients with Alzheimer's disease. J Am Geriatr Soc. 2008 Mar;56(3):413-20. ","doi: 10.1111/j.1532-5415.2007.01569.x. ","Nichols LO, Chang C, Lummus A, Burns R, Martindale-Adams J, Graney MJ, Coon DW, Czaja S, Resources for Enhancing Alzheimer's Caregivers Health II Investigators."," The cost-effectiveness of a behavior intervention with caregivers of patients with Alzheimer's disease.","To examine the cost-effectiveness of a randomized, clinical trial of a home-based intervention for caregivers of people with dementia. This cost-effectiveness analysis examined Resources for Enhancing Alzheimer's Caregivers Health (REACH II), a multisite, randomized, clinical trial, from June 2002 through December 2004, funded by the National Institute on Aging and the National Institute of Nursing Research, of a behavioral intervention to decrease caregivers' stress and improve management of care recipient behavioral problems. Community-dwelling dementia caregiving dyads from the Memphis REACH II site. Of Memphis' random sample of 55 intervention and 57 control black and white dyads, 46 in each arm completed without death or discontinuation. Family caregivers were aged 21 and older, lived with the care recipient, and had provided 4 or more hours of care per day for 6 months or longer. Care recipients were cognitively and functionally impaired. Twelve individual sessions (9 home sessions and 3 telephone sessions) supplemented by five telephone support-group sessions. Control caregivers received two \"check in\" phone calls. Incremental cost-effectiveness ratio (ICER), the additional cost to bring about one additional unit of benefit (hours per day of providing care). At 6 months, there was a significant difference between intervention caregivers and control caregivers in hours providing care (P=.01). The ICER showed that intervention caregivers had 1 extra hour per day not spent in caregiving, at a cost of $5 per day. The intervention provided that most scarce of caregiver commodities--time. The emotional and physical costs of dementia caregiving are enormous, and this intervention was able to alleviate some of that cost."," J Am Geriatr Soc. 2008 Mar;56(3):413-20. ","USA",2008,"Alzheimer’s","Support",null,null,null,"Cost-effectiveness"]
[91,"Graff MJ, Adang EM, Vernooij-Dassen MJ, Dekker J, Jönsson L, Thijssen M, Hoefnagels WH, Rikkert MG. Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study. BMJ. 2008 Jan 19;336(7636):134-8. ","doi: 10.1136/bmj.39408.481898.BE. ","Graff MJ, Adang EM, Vernooij-Dassen MJ, Dekker J, Jönsson L, Thijssen M, Hoefnagels WH, Rikkert MG."," Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study.","To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint. Cost effectiveness study alongside a single blind randomised controlled trial. Memory clinic, day clinic of a geriatrics department, and participants' homes. Patients 135 patients aged > or =65 with mild to moderate dementia living in the community and their primary care givers. 10 sessions of occupational therapy over five weeks, including cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision. Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment (that is, a combined patient and care giver outcome measure of clinically relevant improvement on process, performance, and competence scales) at three months after randomisation. Bootstrap methods used to determine confidence intervals for these measures. The intervention cost 1183 euros (848 pounds sterling, $1738) (95% confidence interval 1128 euros (808 pounds sterling, $1657) to 1239 euros (888 pounds sterling, $1820)) per patient and primary care giver unit at three months. Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were 1748 euros (1279 pounds sterling, $2621) lower in the intervention group, with the main cost savings in informal care. There was a significant difference in proportions of successful treatments of 36% at three months. The number needed to treat for successful treatment at three months was 2.8 (2.7 to 2.9). Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective, especially in terms of informal care giving."," BMJ. 2008 Jan 19;336(7636):134-8. ","Netherlands",2008,"Any dementia","Occupational therapy",null,null,null,"Cost-effectiveness"]
[92,"Getsios D, Migliaccio-Walle K, Caro JJ. NICE cost-effectiveness appraisal of cholinesterase inhibitors: was the right question posed? Were the best tools used? Pharmacoeconomics. 2007;25(12):997-1006.","","Getsios D, Migliaccio-Walle K, Caro JJ."," NICE cost-effectiveness appraisal of cholinesterase inhibitors: was the right question posed? Were the best tools used? Pharmacoeconomics.","The National Institute for Health and Clinical Excellence (NICE) recently issued updated guidance on the use of cholinesterase inhibitors in the treatment of Alzheimer's disease. NICE initially recommended that cholinesterase inhibitors no longer be used, but final guidance restricted treatment to patients with disease of a moderately severe stage. This decision was based largely on results from a heavily criticised economic evaluation that used an adaptation of the Assessment of Health Economics in Alzheimer's Disease (AHEAD) model. As the developers of the AHEAD model, we examined the appropriateness of NICE's economic analyses and presentation of results. We attempted to replicate NICE's results by modifying the original AHEAD model. Sensitivity analyses were then run using the modified AHEAD model to evaluate the extent of uncertainty in predictions. The AHEAD(NICE) analyses resulted in an incremental cost-effectiveness ratio for galantamine of 82,000 pound per QALY gained (year 2003 values) from the perspective of the UK NHS and Personal Social Services. This was later revised to 46,000 pound per QALY, compared with < 9000 pound per discounted QALY gained (year 2001 values) in the original AHEAD model. Using our modified AHEAD with effectiveness estimates matching those of AHEAD(NICE), we show that NICE's choice and presentation of sensitivity analyses obscured the instability of their estimates. In the final NICE evaluation, the recommendation to delay treatment with cholinesterase inhibitors until patients have moderately severe disease was based on critical assumptions in the economic analyses that had little evidence to support them. The case of NICE's guidance on cholinesterase inhibitors highlights the importance of transparent and valid economic evaluations and the dangers of using inappropriate modelling technologies, basing analyses on a limited subset of the available data, and insufficiently reflecting the uncertainty in estimates that are intended to inform decision makers.\n"," 2007;25(12):997-1006.","UK",2007,"Alzheimer’s","Any anticholinesterase,Galantamine",null,null,null,"Cost-utility"]
[93,"Rosenheck RA, Leslie DL, Sindelar JL, Miller EA, Tariot PN, Dagerman KS, Davis SM, Lebowitz BD, Rabins P, Hsiao JK, Lieberman JA, Schneider LS, Clinical Antipsychotic Trial of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) investigators. Cost-benefit analysis of second-generation antipsychotics and placebo in a randomized trial of the treatment of psychosis and aggression in Alzheimer disease. Arch Gen Psychiatry. 2007 Nov;64(11):1259-68. ","doi: 10.1001/archpsyc.64.11.1259.","Rosenheck RA, Leslie DL, Sindelar JL, Miller EA, Tariot PN, Dagerman KS, Davis SM, Lebowitz BD, Rabins P, Hsiao JK, Lieberman JA, Schneider LS, Clinical Antipsychotic Trial of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) investigators."," Cost-benefit analysis of second-generation antipsychotics and placebo in a randomized trial of the treatment of psychosis and aggression in Alzheimer disease.","Second-generation antipsychotics (SGAs) are prescribed for psychosis, aggression, and agitation in Alzheimer disease (AD). To conduct a cost-benefit analysis of SGAs and placebo (taken to represent a \"watchful waiting\" treatment strategy) for psychosis and aggression in outpatients with AD. Randomized placebo-controlled trial of alternative SGA initiation strategies. Forty-two outpatient clinics. Outpatients with AD and psychosis, aggression, or agitation (N = 421). Intervention Participants were randomly assigned to treatment with olanzapine, quetiapine fumarate, risperidone, or placebo with the option of double-blind rerandomization to another antipsychotic or citalopram hydrobromide or open treatment over 9 months. Monthly interviews documented health service use and costs. The economic perspective addressed total health care and medication costs. Costs of study drugs were estimated from wholesale prices with adjustment for discounts and rebates. Quality-adjusted life-years (QALYs) were assessed with the Health Utilities Index Mark 3 and were supplemented with measures of functioning, activities of daily living, and quality of life. Primary analyses were conducted using all available data. Secondary analyses excluded observations after the first medication change (ie, phase 1 only). Cost-benefit analysis was conducted using the net health benefits approach in a sensitivity analysis in which QALYs were valued at $50,000 per year and $100,000 per year. Average total health costs, including medications, were significantly lower for placebo than for SGAs, by $50 to $100 per month. There were no differences between treatments in QALYs or other measures of function. Phase 1-only analyses were broadly similar. Net-benefit analysis showed greater net health benefits for placebo as compared with other treatments, with probabilities ranging from 50% to 90%. There were no differences in measures of effectiveness between initiation of active treatments or placebo (which represented watchful waiting) but the placebo group had significantly lower health care costs. clinicaltrials.gov Identifier: NCT00015548."," Arch Gen Psychiatry. 2007 Nov;64(11):1259-68. ","USA",2007,"Alzheimer’s","Antipsychotics",null,null,null,"Cost-benefit"]
[94,"Gagnon M, Rive B, Hux M, Guilhaume C. Cost-effectiveness of memantine compared with standard care in moderate-to-severe Alzheimer disease in Canada. Can J Psychiatry. 2007 Aug;52(8):519-26.","","Gagnon M, Rive B, Hux M, Guilhaume C."," Cost-effectiveness of memantine compared with standard care in moderate-to-severe Alzheimer disease in Canada.","To conduct a cost-effectiveness analysis comparing the addition of memantine to standard care (that is, without acetylcholinesterase inhibitors) with standard care alone in moderate-to-severe Alzheimer disease (AD) in Canada. A 2-year Markov model estimated clinical effects in terms of quality-adjusted life years (QALYs) and time in complete dependence as well as societal costs in four 6-month cycles. Health states were defined by AD severity assessed with the Mini-Mental State Examination (moderate = 10 to 19; severe < 10), by level of dependence in activities of daily living, and by death. Transition probabilities were estimated by combining data of patients with moderate-to-severe AD from all relevant clinical trials. QALYs were estimated from a UK epidemiologic study. The initial distribution and use of medical and support services for each health state was obtained from the Canadian Study on Health and Aging with current estimates of frequency of use and unit prices applied. Compared with standard care, the memantine strategy saved more than 1 month of complete dependence and produced 0.03 additional QALYs, with no additional cost. Probabilistic sensitivity analyses give an 83.3% chance that memantine treatment is cost-neutral, an 89.5% chance of its being cost-effective if the decision maker is willing to pay $20 000 for a QALY, and a 96.2% chance with a willingness to pay $100 000 per QALY. Robustness of results was confirmed through 1-way and scenario-based sensitivity analyses. Our evaluation found that memantine monotherapy produced relevant health benefit, compared with standard care alone, with no additional costs. Results are consistent with other economic evaluations of memantine conducted in Europe and the United States."," Can J Psychiatry. 2007 Aug;52(8):519-26.","Canada",2007,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility"]
[95,"Ballard C, Sorensen S, Sharp S. Pharmacological therapy for people with Alzheimer's disease: the balance of clinical effectiveness, ethical issues and social and healthcare costs. J Alzheimers Dis. 2007 Aug;12(1):53-9.","","Ballard C, Sorensen S, Sharp S."," Pharmacological therapy for people with Alzheimer's disease: the balance of clinical effectiveness, ethical issues and social and healthcare costs.","The drive for evidence based practice and cost-effective use of pharmacological therapies has advantages, but can also be problematic. These difficulties are particularly challenging in the context of long-term conditions, such as Alzheimer's disease. The complexity of the illness, the variable and complex pattern of service use and the difficulty of conducting long term clinical trials are extremely difficult to factor into a meaningful cost effectiveness model. In Alzheimer's disease, the additional impact on caregivers as well as the person with dementia should be considered. In the current article we give a brief overview of the clinical effectiveness of cholinesterase inhibitors for the treatment of Alzheimer's disease, discuss in detail the NICE appraisal of these treatments in the UK as an example of an attempt at a standardised evaluation of cost-effectiveness and discuss a proposed way forward to achieve a unified and consistent approach to the assessment of cost-effectiveness for anti-dementia therapies."," J Alzheimers Dis. 2007 Aug;12(1):53-9.","UK",2007,"Alzheimer’s","Any anticholinesterase",null,null,null,"Unclear"]
[96,"Green C. Modelling disease progression in Alzheimer's disease: a review of modelling methods used for cost-effectiveness analysis. Pharmacoeconomics. 2007;25(9):735-50. ","","Green C."," Modelling disease progression in Alzheimer's disease: a review of modelling methods used for cost-effectiveness analysis.","The literature reporting economic evaluations related to the treatment of Alzheimer's disease (AD) has developed over the last decade. Most analyses have used economic models to estimate the cost effectiveness of drugs for the treatment of AD. This review considers the range of methods used in the published cost-effectiveness literature to model AD progression and the effect of interventions on the progression of AD. The review builds on and updates an earlier systematic review of cost-effectiveness studies on drugs for AD. Systematic and rigorous methods were used to search the literature for economic evaluations estimating the cost effectiveness of donepezil, rivastigmine, galantamine or memantine in AD. The literature search covered a wide range of electronic databases (e.g. MEDLINE, EMBASE), and included literature from the inception of databases up to the end of 2005. The search identified 22 published economic evaluations. An outline and brief critical review of the identified studies is provided, and thereafter the methods used to model disease progression were considered in more detail. The review employs recent guidance on good practice in decision-analytic modelling in HTA to critically review the modelling methods used. Using this guidance, the models are assessed against the broad criteria of model structure, data inputs and assessment of uncertainty and inconsistency. Concerns were noted over the model structure employed in all models. The reliance on cognitive scores to model AD, the progression of the disease, and the effect of treatment on costs and consequences is regarded as a serious limitation in almost all of the studies identified. There are also limitations over the data used to populate published models, especially around the failure of studies to document and establish the basis for the modelling of treatment effects. It is also clear that studies modelling AD progression, and subsequently the cost effectiveness of treatment, have not addressed uncertainty or consistency (internal and/or external) in sufficient detail. Further research is required on more appropriate methods for the modelling of AD progression. In the meantime, future economic evaluations of treatment need to be more explicit on the methods used to model AD, and the data used to populate models."," Pharmacoeconomics. 2007;25(9):735-50. ","International",2007,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine",null,null,null,"Unclear"]
[97,"Fuh JL, Wang SJ. Cost-effectiveness analysis of donepezil for mild to moderate Alzheimer's disease in Taiwan. Int J Geriatr Psychiatry. 2008 Jan;23(1):73-8. ","doi: 10.1002/gps.1842. ","Fuh JL, Wang SJ."," Cost-effectiveness analysis of donepezil for mild to moderate Alzheimer's disease in Taiwan.","Donepezil is a drug used for treatment in patients with Alzheimer's disease (AD). Information regarding the cost-effectiveness of this medication was previously rare in Asia. We used techniques of decision analysis and economic evaluation in conjunction with available local epidemiological and clinical data on costs of mild to moderate AD to assess the cost-effectiveness of donepezil in Taiwan. A four-state Markov model was built to simulate the disease progression of AD patients. Local transition probabilities and costs of different stages were from the studies published earlier. Over a 5-year span, donepezil treatment for mild or moderate AD patients is predicted to result in the gain of 0.505 QALYs when comparing to usual care, while at the same time reducing the cost by US$7,691. The incremental cost was US$3,647 from the payer perspective; thus, the incremental cost-effectiveness ratio was estimated to be US$7,226 when considering only the medical expenditures. Under some assumptions, donepezil treatment might be a cost saving strategy for mild to moderate AD patients in Taiwan from a societal perspective. It is inconclusive from the payer's part since we still lack a consensus for judging the cost-effectiveness of a new health care technology."," Int J Geriatr Psychiatry. 2008 Jan;23(1):73-8. ","Taiwan",2008,"Alzheimer’s","Donepezil",null,null,null,"Cost-utility"]
[98,"Weycker D, Taneja C, Edelsberg J, Erder MH, Schmitt FA, Setyawan J, Oster G. Cost-effectiveness of memantine in moderate-to-severe Alzheimer's disease patients receiving donepezil. Curr Med Res Opin. 2007 May;23(5):1187-97. ","doi: 10.1185/030079907X188071. ","Weycker D, Taneja C, Edelsberg J, Erder MH, Schmitt FA, Setyawan J, Oster G."," Cost-effectiveness of memantine in moderate-to-severe Alzheimer's disease patients receiving donepezil.","The efficacy and safety of memantine in patients with moderate-to-severe Alzheimer's disease (AD) receiving stable doses of donepezil were recently demonstrated in a phase III trial. The cost-effectiveness of such therapy is unknown. A microsimulation model was developed to depict AD progression over time and associated clinical and economic outcomes. AD progression was measured in terms of decline in cognitive function, as assessed by the Severe Impairment Battery (SIB). At model entry, patients were assumed to have moderate-to-severe AD, to be on stable doses of donepezil, and to begin combination therapy with memantine, or continue to receive donepezil alone; duration of therapy was assumed to be 1 year. Drug efficacy was based on data from a phase III trial. Key assumptions of the model included: (1) efficacy of study drugs would extend to 1 year; (2) measures of cognitive function could be mapped to one another, as well as to global measures of disease severity; and (3) following therapy discontinuation, cognitive function would revert immediately to natural history levels. Cost-effectiveness was assessed in terms of cost (2005 US$) per quality-adjusted life-year (QALY) gained over a lifetime (3% discount rate). SIB scores were estimated to improve by 3.3 over 1 year from therapy with memantine plus donepezil (vs. donepezil alone). While pharmacotherapy costs were estimated to increase by $1250 during the year of memantine treatment, costs of formal and informal services were estimated to decrease by $1240 over this period and by $1493 (discounted present value) over a lifetime. Findings were sensitive to the assumed SIB score at therapy initiation; cost-effectiveness was better for patients with higher initial SIB scores (i.e., less severe disease). In patients with moderate-to-severe AD already receiving donepezil, treatment with memantine results in improved clinical outcomes and reduced total costs of care."," Curr Med Res Opin. 2007 May;23(5):1187-97. ","USA",2007,"Alzheimer’s","Donepezil,Memantine",null,null,null,"Cost-utility"]
[99,"Mason A, Weatherly H, Spilsbury K, Arksey H, Golder S, Adamson J, Drummond M, Glendinning C. A systematic review of the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their carers. Health Technol Assess. 2007 Apr;11(15):1-157, iii.","","Mason A, Weatherly H, Spilsbury K, Arksey H, Golder S, Adamson J, Drummond M, Glendinning C."," A systematic review of the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their carers.","To review the evidence for different models of community-based respite care for frail older people and their carers, where the participant group included older people with frailty, disability, cancer or dementia. Where data permitted, subgroups of carers and care recipients, for whom respite care is particularly effective or cost-effective, were to be identified. Major databases were searched from 1980 to March 2005. Ongoing and recently completed research databases were searched in July 2005. Data from relevant studies were extracted and quality assessed. The possible effects of study quality on the effectiveness data and review findings were discussed. Where sufficient clinically and statistically similar data were available, data were pooled using appropriate statistical techniques. Twenty-two primary studies were included. Most of the evidence came from North America, with a minority of effectiveness and economic studies based in the UK. Types of service studied included day care, host family, in-home, institutional and video respite. Effectiveness evidence suggests that the consequences of respite upon carers and care recipients are generally small, with better controlled studies finding modest benefits only for certain subgroups. However, many studies report high levels of carer satisfaction. No reliable evidence was found that respite can delay entry to residential care or that respite adversely affects care recipients. Randomisation validity in the included randomised studies was sometimes unclear. Studies reported many different outcome measures, and all of the quasi-experimental and uncontrolled studies had methodological weaknesses. The descriptions of the studies did not provide sufficient detail of the methods of data collection or analysis, and the studies failed to describe adequately the groups of study participants. In some studies, only evidence to support respite care services was presented, rather than a balanced view of the services. Only five economic evaluations of respite care services were found, all of which compared day care with usual care and only one study was undertaken in the UK. Day care tended to be associated with higher costs and either similar or a slight increase in benefits, relative to usual care. The economic evaluations were based on two randomised and three quasi-experimental studies, all of which were included in the effectiveness analysis. The majority of studies assessed health and social service use and cost, but inadequate reporting limits the potential for exploring applicability to the UK setting. No study included generic health-related quality of life measures, making cost-effectiveness comparisons with other healthcare programmes difficult. One study used sensitivity analysis to explore the robustness of the findings. The literature review provides some evidence that respite for carers of frail elderly people may have a small positive effect upon carers in terms of burden and mental or physical health. Carers were generally very satisfied with respite. No reliable evidence was found that respite either benefits or adversely affects care recipients, or that it delays entry to residential care. Economic evidence suggests that day care is at least as costly as usual care. Pilot studies are needed to inform full-scale studies of respite in the UK."," Health Technol Assess. 2007 Apr;11(15):1-157, iii.","UK",2007,"Any dementia","Caregiver support",null,null,null,"Unclear"]
[100,"Teipel SJ, Ewers M, Reisig V, Schweikert B, Hampel H, Happich M. Long-term cost-effectiveness of donepezil for the treatment of Alzheimer's disease. Eur Arch Psychiatry Clin Neurosci. 2007 Sep;257(6):330-6. ","doi: 10.1007/s00406-007-0727-1. ","Teipel SJ, Ewers M, Reisig V, Schweikert B, Hampel H, Happich M."," Long-term cost-effectiveness of donepezil for the treatment of Alzheimer's disease.","(Acetyl-)cholinesterase (ChE) inhibitors have been approved for the treatment of mild to moderate Alzheimer's disease (AD). However, use of ChE inhibitors is limited by budget constraints and disincentives on the side of health insurances and nursing care insurances. To analyse under what conditions the application of the acetylcholinesterase inhibitor donepezil is favourable for the treatment of patients with AD from the perspective of health insurance and nursing care insurance companies in Germany, taking into account factors such as start and duration of treatment, duration of follow-up, drug costs, internalization of opportunity costs and varying mortality and efficacy rates. Transition probabilities from a Swedish study and German cost data for donepezil were merged in a Markov model to follow a cohort of patients over a period of 5-10 years. We defined a base case with 1 year treatment and follow-up over 5 years and varied treatment length, follow-up interval and cost factors in sensitivity analyses. In the base case, the ChE inhibitor donepezil did not lead to cost savings but to a cost-effective outcome on side of health insurances and nursing care insurances. Early treatment of AD and internalization of opportunity costs (caring time devoted to patients) led to less costs per quality adjusted life years gained. However, results are very sensitive with respect to varying mortality and efficacy rates. The application of donepezil may be cost-effective, but considerable uncertainties remain. Moreover, the way the reimbursement system in Germany is presently arranged does not support the application of ChE inhibitors."," Eur Arch Psychiatry Clin Neurosci. 2007 Sep;257(6):330-6. ","Germany",2007,"Alzheimer’s","Donepezil",null,null,null,"Cost-utility"]
[101,"Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B, Orrell M. Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis. Br J Psychiatry. 2006 Jun;188():574-80. ","doi: 10.1192/bjp.bp.105.010561.","Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B, Orrell M."," Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis.","Psychological therapy groups for people with dementia are widely used, but their cost-effectiveness has not been explored. To investigate the cost-effectiveness of an evidence-based cognitive stimulation therapy (CST) programme for people with dementia as part of a randomised controlled trial. A total of 91 people with dementia, living in care homes or the community, received a CST group intervention twice weekly for 8 weeks; 70 participants with dementia received treatment as usual. Service use was recorded 8 weeks before and during the 8-week intervention and costs were calculated. A cost-effectiveness analysis was conducted with cognition as the primary outcome, and quality of life as the secondary outcome. Cost-effectiveness acceptability curves were plotted. Cognitive stimulation therapy has benefits for cognition and quality of life in dementia, and costs were not different between the groups. Under reasonable assumptions, there is a high probability that CST is more cost-effective than treatment as usual, with regard to both outcome measures. Cognitive stimulation therapy for people with dementia has effectiveness advantages over, and may be more cost-effective than, treatment as usual."," Br J Psychiatry. 2006 Jun;188():574-80. ","UK",2006,"Any dementia","Cognitive therapies",null,null,null,"Cost-utility"]
[102,"Kirby J, Green C, Loveman E, Clegg A, Picot J, Takeda A, Payne E. A systematic review of the clinical and cost-effectiveness of memantine in patients with moderately severe to severe Alzheimer's disease. Drugs Aging. 2006;23(3):227-40.","","Kirby J, Green C, Loveman E, Clegg A, Picot J, Takeda A, Payne E."," A systematic review of the clinical and cost-effectiveness of memantine in patients with moderately severe to severe Alzheimer's disease.","Alzheimer's disease (AD) is the most common form of dementia and is characterised by a worsening of cognition, functional ability, and behaviour and mood. The objective of this study was to review the clinical and cost-effectiveness of memantine for the treatment of patients with moderately severe to severe AD. To achieve this, a systematic search and review of the clinical and cost effectiveness literature for memantine was undertaken. The literature search covered the period from the inception of MEDLINE, Cochrane Library, EMBASE and other electronic databases until July 2004. The search included randomised controlled trials (RCTs) and full economic evaluations that assessed the use of memantine in patients with moderately severe to severe AD. Two published RCTs were included in this review; in one of these trials the participants were already being treated with donepezil. The two RCTs showed benefit for patients receiving memantine compared with placebo on the outcome measures of the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory modified for severe dementia, the Clinician's Interview-Based Impression of Change Plus Caregiver Input, and the Severe Impairment Battery, and that memantine appeared to be slightly more effective in patients already receiving a stable dose of donepezil. Five cost-effectiveness studies were included in the review. Although these studies reported cost reductions and improved outcomes with memantine, the evaluations were based on a number of assumptions. In conclusion, memantine appears to be beneficial when assessed using functional and global measurements. However, the effect of memantine on cognitive scores and behaviour and mood outcomes is less clear. Cost-effectiveness is dependent upon assumptions surrounding clinical effect and context-specific cost data."," Drugs Aging. 2006;23(3):227-40.","International",2006,"Alzheimer’s","Donepezil,Memantine",null,null,null,"Unclear"]
[103,"Willan AR, Goeree R, Pullenayegum EM, McBurney C, Blackhouse G. Economic evaluation of rivastigmine in patients with Parkinson's disease dementia. Pharmacoeconomics. 2006;24(1):93-106. ","","Willan AR, Goeree R, Pullenayegum EM, McBurney C, Blackhouse G."," Economic evaluation of rivastigmine in patients with Parkinson's disease dementia.","The positive results of a randomised clinical trial of rivastigmine in patients with dementia associated with Parkinson's disease have been published recently. Patient-level healthcare utilisation data were also collected, and this report is the economic evaluation based on these data. To determine the cost effectiveness of rivastigmine 3-12 mg/day in patients in whom mild to moderate dementia developed at least 2 years after they received a clinical diagnosis of Parkinson's disease. A cost-effectiveness analysis was performed by applying Canadian and UK cost weights (year 2004 values) to healthcare utilisation data collected prospectively during a randomised, double-blind, multinational, 24-week trial of rivastigmine 3-12 mg/day (n = 362) versus placebo (n = 179). Patients were > or =50 years of age, had a Mini-Mental State Examination (MMSE) score of between 20 and 24 and had contact with a responsible caregiver at least 3 days a week.Quality-adjusted survival time, transformed from MMSE scores, was the measure of effectiveness. Caregiver costs included paid and unpaid time, and direct costs included concomitant medications, outpatient care, hospitalisations, long-term care and study medications. Analysis was conducted from a societal perspective with a time horizon of 24 weeks. Consistent with the improvement in clinical outcomes, there was an observed increase in quality-adjusted survival time in the rivastigmine arm of 2.81 quality-adjusted life-days (two-sided p-value 0.13 [90% CI -0.243, 5.86]). Using Canadian price weights, there was an observed increase in cost in the rivastigmine arm of Can 55.76 dollars(two-sided p-value 0.98 [90% CI -3431, 3543]), with a resulting incremental cost-effectiveness ratio of Can 7429 dollars per QALY. Using UK price weights, there was an observed decrease in cost in the rivastigmine arm of pound 26.18 (two-sided p-value 0.99 [90% CI -2407, 2355]). Although no between-treatment differences in cost were seen, the small sample size, highly variable cost distributions and short time horizon prevent us from making strong conclusions with regard to the effect of rivastigmine on total costs and, by inference, on cost effectiveness."," Pharmacoeconomics. 2006;24(1):93-106. ","Canada,UK",2006,"Parkinson’s dementia","Rivastigmine",null,null,null,"Cost-utility"]
[104,"Loveman E, Green C, Kirby J, Takeda A, Picot J, Payne E, Clegg A. The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease. Health Technol Assess. 2006 Jan;10(1):iii-iv, ix-xi, 1-160.","","Loveman E, Green C, Kirby J, Takeda A, Picot J, Payne E, Clegg A."," The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease.","To provide an update review of the best quality evidence for the clinical effectiveness and cost-effectiveness of donepezil, rivastigmine and galantamine for mild to moderately severe Alzheimer's disease (AD) and of memantine for moderately severe to severe AD. Electronic databases, experts in the field and manufacturer submissions to the National Institute for Health and Clinical Excellence (NICE). A systematic review of the literature and an economic evaluation were undertaken. The quality of included randomised controlled trials (RCTs) was assessed using criteria developed by the NHS Centre for Reviews and Dissemination. An outline assessment of economic evaluations was undertaken using a standard checklist. The clinical and cost-effectiveness data were synthesised through a narrative review with full tabulation of the results of included studies. Where appropriate, meta-analysis of data was undertaken. For mild to moderately severe AD, the results of the study suggested that all three treatments were beneficial when assessed using cognitive outcome measures. Global outcome measures were positive for donepezil and rivastigmine, but mixed for galantamine. Results for measures of function were mixed for donepezil and rivastigmine, but positive for galantamine. Behaviour and mood measures were mixed for donepezil and galantamine, but showed no benefit for rivastigmine. For memantine, two published RCTs were included; in one of these trials the participants were already being treated with donepezil. The results suggest that memantine is beneficial when assessed using functional and global measurements. The effect of memantine on cognitive and behaviour and mood outcomes is, however, less clear. Literature on the cost-effectiveness of donepezil, rivastigmine and galantamine was dominated by industry-sponsored studies, and studies varied in methods and results. Of the three UK studies, two report donepezil as not cost-effective, whereas a third study reports an additional cost (1996 pounds sterling) of between 1200 pounds sterling and 7000 pounds sterling per year in a non-severe AD health state (concerns over these estimates are raised, suggesting that they may underestimate the true cost-effectiveness of donepezil). Cost-effectiveness analysis undertaken in this review suggests that donepezil treatment has a cost per quality-adjusted life-year (QALY) in excess of 80,000 pounds sterling, with donepezil treatment reducing the mean time spent in full-time care (delays progression of AD) by 1.42-1.59 months (over a 5-year period). From four published cost-effectiveness studies, two UK studies report additional costs associated with rivastigmine treatment. Cost-effectiveness analysis undertaken in the current review suggests that rivastigmine treatment has a cost per QALY in excess of 57,000 pounds sterling, with rivastigmine treatment reducing the mean time spent in full-time care (delays progression) by 1.43-1.63 months (over a 5-year period). From five published cost-effectiveness studies, one UK study reports a cost per QALY of 8693 pounds sterling for 16-mg galantamine treatment and 10,051 pounds sterling for 24-mg galantamine treatment (concerns raised suggest that this may underestimate the true cost-effectiveness of galantamine). Cost-effectiveness analysis undertaken in the present review suggests that galantamine treatment has a cost per QALY in excess of 68,000 pounds sterling, with galantamine reducing the time spent in full-time care (delays progression) by 1.42-1.73 months (over a 5-year period). From two published cost-effectiveness studies, one reports analysis for the UK, finding that memantine treatment results in cost savings and benefits in terms of delaying disease progression (concerns raised suggest that this may underestimate the true cost-effectiveness of memantine). In the current review, the cost-effectiveness of memantine has not been modelled separately, but where alternative parameter inputs on the cost structure and utility values have been used in a reanalysis using the industry model, the cost-effectiveness is reported at between 37,000 pounds sterling and 52,000 pounds sterling per QALY, with this alternative analysis still based on what is regarded as an optimistic or favourable effectiveness profile for memantine. Although results from the clinical effectiveness review suggest that these treatments may be beneficial, a number of issues need to be considered when assessing the results of the present review, such as the characteristics of the participants included in the individual trials, the outcome measures used, the length of study duration, the effects of attrition and the relationship between statistical significance and clinical significance. Many included trials were sponsored by industry. For donepezil, rivastigmine and galantamine, the cost savings associated with reducing the mean time spent in full-time care do not offset the cost of treatment sufficiently to bring estimated cost-effectiveness to levels generally considered acceptable by NHS policy makers. It is difficult to draw conclusions on the cost-effectiveness of memantine; it is suggested that further amendments to the potentially optimistic industry model (measure of effect) would offer higher cost per QALY estimates. Future research should include: information on the quality of the outcome measures used; development of quality of life instruments for patients and carers; studies assessing the effects of these interventions of durations longer than 12 months; comparisons of benefits between interventions; and research on the prediction of disease progression."," Health Technol Assess. 2006 Jan;10(1):iii-iv, ix-xi, 1-160.","UK",2006,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine",null,null,null,"Cost-utility"]
[105,"Jansen AP, van Hout HP, van Marwijk HW, Nijpels G, de Bruijne MC, Bosmans JE, Pot AM, Stalman WA. (Cost)-effectiveness of case-management by district nurses among primary informal caregivers of older adults with dementia symptoms and the older adults who receive informal care: design of a randomized controlled trial [ISCRTN83135728]. BMC Public Health. 2005 Dec 12;5():133. ","doi: 10.1186/1471-2458-5-133. ","Jansen AP, van Hout HP, van Marwijk HW, Nijpels G, de Bruijne MC, Bosmans JE, Pot AM, Stalman WA."," (Cost)-effectiveness of case-management by district nurses among primary informal caregivers of older adults with dementia symptoms and the older adults who receive informal care: design of a randomized controlled trial [ISCRTN83135728].","Dementia is an incurable disease with devastating consequences for both patients and their relatives. The objective of this study is to describe the study protocol of a randomized controlled trial with assignment to either usual care or case-management by district nurses, among informal caregivers of older adults with dementia symptoms who live at home and the older adults who receive informal care. In this randomized controlled trial, effectiveness as well as cost-effectiveness of case-management is evaluated. It concerns case-management in early-detected patients with dementia symptoms and their primary informal caregivers. Participants are followed up to twelve months after baseline assessment. The main outcome measure of the effect evaluation is the caregiver's sense of competence to care for the older person with dementia symptoms. The economic evaluation is performed from a societal perspective. This is one of the first trials on case-management that includes an economic evaluation. In addition, it concerns a tailor-made intervention in early-detected patients with dementia symptoms and their caregivers. The results of this randomized controlled trial will provide valuable information for health professionals and policy makers on effectiveness and cost-effectiveness of early tailor-made case-management for patients and their informal caregivers. Moreover, positive effects will challenge current health care systems to move to more pro-active approaches for this group."," BMC Public Health. 2005 Dec 12;5():133. ","Netherlands",2005,"Any dementia","Disease management",null,null,null,"Unclear"]
[106,"Green C, Picot J, Loveman E, Takeda A, Kirby J, Clegg A. Modelling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderately severe Alzheimer's disease. Pharmacoeconomics. 2005;23(12):1271-82. ","","Green C, Picot J, Loveman E, Takeda A, Kirby J, Clegg A."," Modelling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderately severe Alzheimer's disease.","To estimate the cost effectiveness (from the UK NHS and personal social services perspective) of the cholinesterase inhibitors donepezil, rivastigmine and galantamine compared with usual care in the treatment of mild to moderately severe Alzheimer's disease. Patients had a mean age of 74 years, a mean disease duration of 1 year and a mean Alzheimer's disease assessment scale-cognitive subscale score of 24. A pharmacoeconomic model was used to predict long-term outcomes over a 5-year time horizon and to estimate the cost effectiveness of cholinesterase inhibitors for the management of Alzheimer's disease. The model structure is informed by a systematic review of the literature on the clinical and cost effectiveness of cholinesterase inhibitors and a review of the literature on the costs and outcomes associated with treatment for Alzheimer's disease. The main outcome measure used was the cost per quality-adjusted life-year (QALY) gained. All healthcare costs (excluding cholinesterase inhibitor costs) were indexed to pounds sterling (2003 values). Drug costs are 2005 values. Multivariate probabilistic sensitivity analysis and scenario analysis were undertaken to assess uncertainty in the results. The clinical benefits on cognition from treatment with cholinesterase inhibitors resulted in an incremental cost per QALY gained ranging from 53,780 pounds sterling to 74,735 pounds sterling, over 5 years (vs usual care). Uncertainty analysis suggests that the probability of any of these treatments having an incremental cost per QALY of < 30,000 pounds sterling is < 21%. The key determinants of cost effectiveness were the effectiveness of treatment, the mean treatment cost and the cost savings associated with an expected delay in disease progression. Results presented in this paper suggest that the use of cholinesterase inhibitors may not be a cost-effective use of NHS resources. Guidance from the National Institute for Health and Clinical Effectiveness (NICE) in the UK on their judgements surrounding the acceptability of technologies as an effective use of resources, indicates there would need to be special reasons for accepting cholinesterase inhibitors as a cost-effective use of NHS resources."," Pharmacoeconomics. 2005;23(12):1271-82. ","UK",2005,"Alzheimer’s","Donepezil,Galantamine,Rivastigmine,",null,null,null,"Cost-utility"]
[107,"Jönsson L. Cost-effectiveness of memantine for moderate to severe Alzheimer's disease in Sweden. Am J Geriatr Pharmacother. 2005 Jun;3(2):77-86. ","doi: 10.1016/j.amjopharm.2005.05.002.","Jönsson L."," Cost-effectiveness of memantine for moderate to severe Alzheimer's disease in Sweden.","Alzheimer's disease entails enormous costs for society and impairs quality of life for patients and caregivers. This study estimated the cost-effectiveness of memantine in the treatment of patients with moderately severe to severe cognitive impairment from Alzheimer's disease in Sweden. The study was based on published data from several sources, including a randomized controlled trial of memantine versus placebo and a longitudinal observational study of Alzheimer's disease patients in Sweden. Costs were estimated from the public payer's perspective, including direct costs but excluding costs of informal care, and resource utilization data were taken from the observational study. Cost-effectiveness was quantified as quality-adjusted life-years (QALYs) gained from treatment with the use of previously published utility weights. A Markov simulation model was constructed, incorporating the effect of treatment on cognitive function, physical dependence related to activities of daily living, and institutionalization. Costs and effects for treated and untreated patients were estimated for 5 years (10 cycles). In the base-case analysis, treatment costs were added for 2 years, but the effect on transition probabilities was applied only for the first year of treatment. Compared with no treatment, memantine treatment was predicted to be associated with lower costs of care, longer time to dependence and institutionalization, and gains in QALYs. Treatment was estimated to decrease formal care costs by 123,600 Swedish kronor (SEK) and, after taking into account the cost of memantine, to lead to net cost savings of 100,528 SEK per patient. Treated patients gained 0.148 QALY over the 5-year simulation. From a public payer's perspective, the observed effect of memantine on cognitive and physical function is predicted to translate into economic benefits that offset the added treatment cost. Treatment is also predicted to delay institutionalization, improve independence, and increase QALYs."," Am J Geriatr Pharmacother. 2005 Jun;3(2):77-86. ","Sweden",2005,"Alzheimer’s","Memantine",null,null,null,"Cost-utility"]
[108,"Plosker GL, Lyseng-Williamson KA. Memantine: a pharmacoeconomic review of its use in moderate-to-severe Alzheimer's disease. Pharmacoeconomics. 2005;23(2):193-206.","","Plosker GL, Lyseng-Williamson KA."," Memantine: a pharmacoeconomic review of its use in moderate-to-severe Alzheimer's disease.","Memantine (Ebixa, Namenda, Axura) is an uncompetitive NMDA receptor antagonist used in the management of patients with moderate-to-severe Alzheimer's disease. It is currently the only drug approved for use in these more advanced stages of the disease. Significant reductions in functional and cognitive decline have been demonstrated with memantine relative to placebo in randomised, double-blind trials in this patient population. Clinical trial and postmarketing surveillance data indicate that the drug is generally well tolerated. Two fully published modelled cost-effectiveness analyses of memantine in moderate-to-severe Alzheimer's disease have been conducted in the UK and Finland, in which patient progression was simulated through health states related to dependency, residential setting and cognitive function. Although the specific costs included in the analyses varied, as did the study perspective and geographical location, results of the base-case analyses consistently showed that memantine was dominant over no pharmacological treatment. In the UK and Finnish analyses, memantine increased the duration of independence by 1.3 and 4.1 months, respectively, and the time to institutionalisation by 0.8 and 1 month. Mean total per-patient costs were reduced by 1963 pounds over 2 years (2003 costs) in the UK analysis and by 1687 eurossover 5 years (2001 costs) in the Finnish analysis. Memantine was also associated with a small gain in quality-adjusted life expectancy in the UK model. In sensitivity analyses, memantine remained dominant for almost all plausible changes to key variables. Memantine reduced total societal costs by $1090 per patient per month (1999 costs) compared with no pharmacological treatment over 28 weeks in a resource utilisation and cost analysis conducted alongside a pivotal US trial in patients with moderate-to-severe Alzheimer's disease. Results were primarily driven by reductions in total caregiver costs, which included the opportunity cost of time spent in caregiving tasks, and in direct nonmedical costs, which included the cost of care in a nursing home or similar institution.In conclusion, in patients with moderate-to-severe Alzheimer's disease, memantine is associated with significant reductions in functional and cognitive decline compared with no pharmacological treatment. Available pharmacoeconomic data from Europe and the US, despite some inherent limitations, support the use of memantine as a cost-effective treatment in this patient population, although definitive conclusions are not feasible because of limited data."," Pharmacoeconomics. 2005;23(2):193-206.","International",2005,"Alzheimer’s","Memantine",null,null,null,"Cost-utility"]
[109,"Martikainen J, Valtonen H, Pirttilä T. Potential cost-effectiveness of a family-based program in mild Alzheimer's disease patients. Eur J Health Econ. 2004 Jun;5(2):136-42. ","doi: 10.1007/s10198-003-0214-1.","Martikainen J, Valtonen H, Pirttilä T."," Potential cost-effectiveness of a family-based program in mild Alzheimer's disease patients.","Alzheimer's disease (AD) is a chronic and progressive neurodegenerative disease characterized by a progressive deterioration in cognitive functions. AD will have a major impact on public health in the coming decades. The objective of this study was to evaluate the potential cost-effectiveness of a cognitive-behavioral family intervention (CBFI) program in patients with mild Alzheimer's disease in Finland. A second-order Monte Carlo technique was used to simulate the effectiveness of the intervention in AD patients and their informal caregivers over the course of 5 years. A Bayesian approach was applied to answer the question: how likely is it that the CBFI program is cost-effective? Based on existing information, the incremental net health benefit of the CBFI program is positive with over 0.9 probability, which indicates that the CBFI program has the highest probability of being optimal by providing greater net benefits than current practice. Furthermore, changes in the health-related quality of life of the caregivers were insensitive to AD patients' disease stage and settings of care. From the methodological point of view, the acceptability curve with a Bayesian approach provides a flexible way to characterize uncertainty surrounding cost-effectiveness parameters."," Eur J Health Econ. 2004 Jun;5(2):136-42. ","Finland",2004,"Alzheimer’s","Other psychological therapies",null,null,null,"Cost-utility"]
[110,"Jones RW, McCrone P, Guilhaume C. Cost effectiveness of memantine in Alzheimer's disease: an analysis based on a probabilistic Markov model from a UK perspective. Drugs Aging. 2004;21(9):607-20.","","Jones RW, McCrone P, Guilhaume C."," Cost effectiveness of memantine in Alzheimer's disease: an analysis based on a probabilistic Markov model from a UK perspective.","Clinical trials with memantine, an uncompetitive moderate-affinity NMDA antagonist, have shown improved clinical outcomes, increased independence and a trend towards delayed institutionalisation in patients with moderately severe-to-severe Alzheimer's disease. In a randomised double-blind, placebo-controlled, 28-week study conducted in the US, reductions in resource utilisation and total healthcare costs were noted with memantine relative to placebo. While these findings suggest that, compared with placebo, memantine provides cost savings, further analyses may help to quantify potential economic gains over a longer treatment period. To evaluate the cost effectiveness of memantine therapy compared with no pharmacological treatment in patients with moderately severe-to-severe Alzheimer's disease over a 2-year period. A Markov model was constructed to simulate patient progression through a series of health states related to severity, dependency (determined by patient scores on the Alzheimer's Disease Cooperative Study-Activities of Daily Living [ADCS-ADL] inventory and residential status ('institutionalisation') with a time horizon of 2 years (each 6-month Markov cycle was repeated four times). Transition probabilities from one health state to another 6 months later were mainly derived from a 28-week, randomised, double-blind, placebo-controlled clinical trial. Inputs related to epidemiological and cost data were derived from a UK longitudinal epidemiological study, while data on quality-adjusted life-years (QALYs) were derived from a Danish longitudinal study. To ensure conservative estimates from the model, the base case analysis assumed drug effectiveness was limited to 12 months. Monte Carlo simulations were performed for each state parameter following definition of a priori distributions for the main variables of the model. Sensitivity analyses included worst case scenario in which memantine was effective for 6 months and one-way sensitivity analyses on key parameters. Finally, a subgroup analysis was performed to determine which patients were most likely to benefit from memantine. Informal care was not included in this model as the costs were considered from National Health Service and Personal Social Services perspective. The base case analysis found that, compared with no treatment, memantine was associated with lower costs and greater clinical effectiveness in terms of years of independence, years in the community and QALYs. Sensitivity analyses supported these findings. For each category of Alzheimer's disease patient examined, treatment with memantine was a cost-effective strategy. The greatest economic gain of memantine treatment was in independent patients with a Mini-Mental State Examination score of > or =10. This model suggests that memantine treatment is cost effective and provides cost savings compared with no pharmacological treatment. These benefits appear to result from prolonged patient independence and delayed institutionalisation for moderately severe and severe Alzheimer's disease patients on memantine compared with no pharmacological treatment."," Drugs Aging. 2004;21(9):607-20.","UK",2004,"Alzheimer’s","Memantine",null,null,null,"Cost-utility"]
[111,"Wimo A. Cost effectiveness of cholinesterase inhibitors in the treatment of Alzheimer's disease: a review with methodological considerations. Drugs Aging. 2004;21(5):279-95. ","","Wimo A."," Cost effectiveness of cholinesterase inhibitors in the treatment of Alzheimer's disease: a review with methodological considerations.","Cholinesterase inhibitors have been available for the treatment of Alzheimer's disease since 1993. They have significantly positive effects on cognitive functioning and other domains of functional capacity, such as activities of daily life in terms of efficacy, but the clinical value of these effects are under discussion. Cholinesterase inhibitors may also influence behavioural and psychological symptoms in Alzheimer's disease. Cholinesterase inhibitors are also regarded as rather expensive and, therefore, the question of cost effectiveness is essential. Pharmacoeconomic evaluations of cholinesterase inhibitors have so far been conducted in retrospect on efficacy data from prospective randomised clinical trials combined with economic data from other sources. There are no published specific cost-effectiveness studies of cholinesterase inhibitors which prospectively collected empirical data on costs and outcomes. There is only one published randomised clinical trial with such empirical data with a cost consequence analysis design, indicating cost neutrality. Several types of models to describe the long-term effects have been published, indicating cost effectiveness. However, due to methodological considerations, the validity of these models is difficult to judge. A research agenda for the cost effectiveness of cholinesterase inhibitors is proposed, including long-term studies with empirical data on resource use, costs and outcomes, studies on quality of life, informal care and behavioural and psychological symptoms, combination and comparative studies on mild cognitive impairment."," Drugs Aging. 2004;21(5):279-95. ","International",2004,"Alzheimer’s","Any anticholinesterase",null,null,null,"Unclear"]
[112,"McMahon PM, Araki SS, Sandberg EA, Neumann PJ, Gazelle GS. Cost-effectiveness of PET in the diagnosis of Alzheimer disease. Radiology. 2003 Aug;228(2):515-22. ","doi: 10.1148/radiol.2282020915. ","McMahon PM, Araki SS, Sandberg EA, Neumann PJ, Gazelle GS."," Cost-effectiveness of PET in the diagnosis of Alzheimer disease.","To evaluate the cost-effectiveness of positron emission tomography (PET) in the diagnosis of Alzheimer disease (AD) in community-dwelling patients with mild or moderate dementia who present to specialized AD centers. A decision-analytic model was used to compare costs and quality-adjusted life years (QALYs) associated with strategies involving single photon emission computed tomography (SPECT), dynamic susceptibility-weighted contrast material-enhanced magnetic resonance (MR) imaging, and PET as functional imaging adjuncts to the standard clinical work-up. Sensitivity analyses were performed to examine changes in test characteristics, health-related quality-of-life survey instruments, therapeutic effectiveness, and treatment rules. The use of PET to confirm the results of the standard clinical work-up cost more but yielded fewer benefits than a strategy in which dynamic susceptibility-weighted contrast-enhanced MR imaging was substituted for the typically performed structural computed tomography. This relationship remained stable in scenarios in which standard diagnostic work-up accuracy, drug treatment effectiveness, and version of the Health Utilities Index were altered. Dynamic susceptibility-weighted contrast-enhanced MR imaging cost US dollars 598800 per QALY gained (range, US dollars 74400 to US dollars 1.9 million per QALY), compared with the cost of the standard diagnostic work-up. Treating all patients with dementia was the dominant imaging strategy, except when side effects in patients with non-AD-related dementia were modeled. In all scenarios, SPECT yielded fewer benefits than other strategies at a higher cost. PET may have high diagnostic accuracy, but adding it to the standard diagnostic regimen at AD clinics would yield limited, if any, benefits at very high costs."," Radiology. 2003 Aug;228(2):515-22. ","USA",2003,"Alzheimer’s","Diagnosis",null,null,null,"Cost-utility"]
[113,"Leung GM, Yeung RY, Chi I, Chu LW. The economics of Alzheimer disease. Dement Geriatr Cogn Disord. 2003;15(1):34-43. ","doi: 66675. ","Leung GM, Yeung RY, Chi I, Chu LW."," The economics of Alzheimer disease.","Economic assessments of health and healthcare have become an integral part of policy decisions in the last decade. Increasingly, this trend is extending to medical decision-making in day-to-day patient-provider interactions. Alzheimer disease (AD) offers a potent example of the clinical and economic issues at stake with its diagnostic techniques, pharmacotherapies, and public health and policy implications. This review introduces basic economic concepts in examining the impact of AD and related care. It presents a summary of the latest economics research on cost estimates of AD and on economic evaluations of diagnostic and management interventions in terms of cost-of-illness and cost-effectiveness studies respectively. Empirical and conceptual issues about the interpretation of costs and the uses of evaluative methods are also discussed. We found that the economic costs attributable to AD care is highly variable mostly due to non-standardised methodologies and geographical variations in care patterns. There is, however, little doubt that the impact is substantial and is expected to worsen with the demographic, epidemiologic, technologic and economic transitions worldwide. There are comparatively fewer studies on the cost-effectiveness of interventions in AD. Most of the published work revolves around pharmacotherapeutics while relatively little has been done on diagnostics, patient care programmes and programmes for caregivers. We conclude that there are significant opportunities to strengthen research on standardised cost-of-illness analyses and new cost-effectiveness studies on a broader range of AD interventions."," Dement Geriatr Cogn Disord. 2003;15(1):34-43. ","International",2003,"Alzheimer’s","None or unclear",null,null,null,"Unclear"]
[114,"Clegg A, Bryant J, Nicholson T, McIntyre L, De Broe S, Gerard K, Waugh N. Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for Alzheimer's disease. A systematic review. Int J Technol Assess Health Care. 2002 Summer;18(3):497-507.","","Clegg A, Bryant J, Nicholson T, McIntyre L, De Broe S, Gerard K, Waugh N."," Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for Alzheimer's disease.","Systematic review of the clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for people suffering from Alzheimer's disease. Sixteen electronic databases (including MEDLINE, the Cochrane Library, and Embase) and bibliographies of related papers were searched for published/unpublished English language studies, and experts and pharmaceutical companies were consulted for additional information. Randomized controlled trials (RCTs) and economic studies were selected. Clinical effectiveness was assessed on measurement scales assessing progression of Alzheimer's disease on the person's global health, cognition, functional ability, behavior and mood, and quality of life. Cost-effectiveness was presented as incremental cost per year spent in a nonsevere state (by Mini Mental Health State Examination) or quality-adjusted life-year. Twelve of 15 RCTs included were judged to be of good quality. Although donepezil had beneficial effects in Alzheimer's patients on global health and cognition, rivastigmine on global health, and galantamine on global health, cognition, and functional scales, these improvements were small and may not be clinically significant. Measures of quality of life and behavior and mood were rarely assessed. Adverse effects were usually mild and transient. Cost-effectiveness base case estimates ranged from 2,415 Pounds savings to 49,476 Pounds additional cost (1997 prices) per unit of effect for donepezil and a small savings for rivastigmine. Estimates were not considered robust or generalizable. Donepezil, rivastigmine, and galantamine appear to have some clinical effect for people with Alzheimer's disease, although the extent to which these translate into real differences in everyday life remains unclear. Due to the nature of current economic studies, cost-effectiveness remains uncertain and the impact on different care sectors has been inadequately investigated. Further research is needed to establish the actual benefits of acetylcholinesterase inhibitors (AChEls) for people with Alzheimer's disease and their caregivers, the relationship of these changes to clinical management, and careful prospective evaluation of resource and budgetary consequences."," A systematic review. Int J Technol Assess Health Care. 2002 Summer;18(3):497-507.","International",2002,"Alzheimer’s","Donepezil,Galantamine,Rivastigmine",null,null,null,"Cost-effectiveness,Cost-utility"]
[115,"Wolfson C, Oremus M, Shukla V, Momoli F, Demers L, Perrault A, Moride Y. Donepezil and rivastigmine in the treatment of Alzheimer's disease: a best-evidence synthesis of the published data on their efficacy and cost-effectiveness. Clin Ther. 2002 Jun;24(6):862-86; discussion 837.","","Wolfson C, Oremus M, Shukla V, Momoli F, Demers L, Perrault A, Moride Y."," Donepezil and rivastigmine in the treatment of Alzheimer's disease: a best-evidence synthesis of the published data on their efficacy and cost-effectiveness.","Various drugs have been approved for the treatment of Alzheimer's disease (AD) in the United States and Canada, including donepezil and rivastigmine, although questions remain as to their efficacy, effectiveness, and long-term benefits. The goal of this study was to conduct a best-evidence synthesis of data on the efficacy and cost-effectiveness of donepezil and rivastigmine in the treatment of AD. Relevant published randomized controlled trials (RCTs) and Phase IV open-label extension studies (excluding abstracts) were identified through searches of MEDLINE, HealthSTAR, and PsycINFO for the period January 1984 to October 2001. The bibliographies of retrieved articles were searched for additional publications. For inclusion in the best-evidence synthesis, clinical trials had to pass a blinded quality assessment (score > or =5 on the Jadad scale) and use National Institute of Neurological and Communicative Disease and Stroke-Alzheimer's Disease and Related Disorders Association diagnostic criteria. Economic studies were selected using National Health Service Centre for Reviews and Dissemination criteria for reporting critical summaries of economic evaluations. Nine RCTs of donepezil and 2 of rivastigmine were identified and met inclusion criteria for the best-evidence synthesis. Eight donepezil trials and both rivastigmine trials included patients with mild AD (Mini-Mental State Examination [MMSE] score, 15-27) or moderate AD (MMSE score, 8-14); 1 donepezil trial included patients with moderate or severe AD (MMSE score, 0-7). In the RCTs of donepezil, the mean decrease in scores on the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) was greater with active treatment than with placebo (lower scores indicate less cognitive deterioration). In the RCTs of rivastigmine, ADAS-cog scores decreased over the follow-up period with both active treatment and placebo; however, scores decreased more with active treatment. Three Phase IV studies of donepezil and I Phase IV study of rivastigmine were identified. Their results were consistent with those of the RCTs. Ten economic studies (7 donepezil, 3 rivastigmine) were identified and reviewed. In 4 of the donepezil studies and all 3 rivastigmine studies, use of the drug cost less than a no-drug strategy. The efficacy data indicate that both donepezil and rivastigmine can delay cognitive impairment and deterioration in global health for at least 6 months in patients with mild to moderate AD. Patients receiving active treatment will have more favorable ADAS-cog scores for at least 6 months, after which their scores will begin to converge with those of patients receiving placebo. Differences in methodology, types of direct or indirect costs included, and sources of cost data made it difficult to compare and synthesize findings of the economic studies; therefore, the cost-effectiveness data are inconclusive."," Clin Ther. 2002 Jun;24(6):862-86; discussion 837.","International",2002,"Alzheimer’s","Donepezil,Rivastigmine",null,null,null,"Unclear"]
[116,"Lamb HM, Goa KL. Rivastigmine.  A pharmacoeconomic review of its use in Alzheimer's disease. Pharmacoeconomics. 2001;19(3):303-18.","","Lamb HM, Goa KL."," Rivastigmine.  A pharmacoeconomic review of its use in Alzheimer's disease. ","Alzheimer's disease is associated with a large cost burden, of which institutionalised care constitutes a major component. Therefore, the decision to move a patient from the community to institutionalised care is associated with a significant increase in direct costs. About three-quarters of patients with Alzheimer's disease are admitted to a nursing home within 5 years of diagnosis. Unpaid or informal caregiver time is another large cost in Alzheimer's disease, especially for patients cared for in the community; informal care can account for up to three-quarters of healthcare costs in non-institutionalised patients. Several cholinesterase inhibitors, of which rivastigmine is one, are available for the treatment of patients with mild to moderate Alzheimer's disease. By improving cognitive function and slowing the rate of cognitive decline, cholinesterase inhibitor therapy may reduce a significant part of the economic burden of the disease by delaying the move to institutionalised care. In the absence of prospective long term data which focus on pharmacoeconomic end-points, modelling techniques have been used to extrapolate clinical data available for some cholinesterase inhibitors, including rivastigmine. Four economic analyses, based on a single model of cognitive decline, have been performed with rivastigmine from the perspective of the provider or society. All show that rivastigmine therapy (excluding drug-related costs) is associated with cost savings in patients with mild to moderate Alzheimer's disease by delaying the time to institutionalisation. If the acquisition cost of the drug was factored in, the cost savings completely or partially offset treatment costs. The magnitude of the cost savings increased as the time horizon increased (up to 2 years). The largest savings were realised in patients with mild disease over a 2-year time-frame, suggesting that treatment should be initiated early from an economic viewpoint. Pharmacoeonomic data comparing different cholinesterase inhibitors are, as yet, unavailable. Pharmacoeconomic analyses, based on modelled data excluding drug costs, indicate that rivastigmine completely or partially offsets the costs of treatment by delaying cognitive decline and the time to institutionalisation in patients with mild to moderate Alzheimer's disease. From a societal perspective, cost savings are realised if the drug is introduced early in the disease. Additional benefits offered by rivastigmine on behavioural symptoms, which may reduce caregiver burden, have yet to be investigated from a pharmacoeconomic perspective.","Pharmacoeconomics. 2001;19(3):303-18.","International",2001,"Alzheimer’s","Rivastigmine",null,null,null,"Unclear"]
[117,"Clegg A, Bryant J, Nicholson T, McIntyre L, De Broe S, Gerard K, Waugh N. Clinical and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer's disease: a rapid and systematic review. Health Technol Assess. 2001;5(1):1-137. ","","Clegg A, Bryant J, Nicholson T, McIntyre L, De Broe S, Gerard K, Waugh N."," Clinical and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer's disease: a rapid and systematic review.","Alzheimer's disease is the most common cause of dementia and is characterised by an insidious onset and slow deterioration. The estimated prevalence of Alzheimer's disease for a standard health authority (500,000 people) is about 3330. Current service involves a wide range of agencies, and drug therapy for some patients. To provide a rapid and systematic review of the clinical effectiveness and cost-effectiveness of donepezil, rivastigmine and galantamine in the symptomatic treatment of people suffering from Alzheimer's disease. A systematic review of the literature was undertaken. METHODS - DATA SOURCES: Searches were made of electronic databases, including MEDLINE, EMBASE, The Cochrane Library, Database of Abstracts of Reviews of Effectiveness, NHS Economic Evaluation Database, National Research Register, Science Citation Index, BIOSIS, EconLit, MRC Trials database, Early Warning System, Current Controlled Trials, TOXLINE, Index of Scientific and Technical Proceedings, and Getting Easier Access to Reviews. All sources were searched over the period covered by the databases up to March/July 2000. Bibliographies of related papers were assessed for relevant studies and experts were contacted for advice and peer review, and to identify additional published and unpublished references. Manufacturer submissions to the National Institute for Clinical Excellence (NICE) were reviewed. Studies were included if they fulfilled the following criteria: (1) INTERVENTION: donepezil, rivastigmine or galantamine used to treat Alzheimer's disease. (2) PARTICIPANTS: people diagnosed with Alzheimer's disease who meet the criteria for treatment with donepezil, rivastigmine and galantamine. (3) OUTCOMES: measures assessing changes in cognition, function, behaviour and mood, quality of life (including studies assessing carer well-being and carer-input), and time to institutionalisation. (4) DESIGN: systematic reviews of randomised controlled trials (RCTs) and RCTs comparing donepezil, rivastigmine or galantamine with placebo or each other or non-drug comparators were included in the review of effectiveness. Economic studies of donepezil, rivastigmine or galantamine used to treat Alzheimer's disease that included a comparator (or placebo) and both the costs and consequence (outcomes) of treatment were included in the review of cost-effectiveness. Studies in non-English language, and abstracts and conference poster presentations of systematic reviews, RCTs and economic evaluations were excluded. Two reviewers identified studies by independently screening study titles and abstracts, and then by examining the full text of selected studies to decide inclusion. METHODS - DATA EXTRACTION AND QUALITY ASSESSMENT: Data extraction and quality assessment were undertaken by one reviewer and checked by a second reviewer, with any disagreements resolved through discussion. The quality of RCTs was assessed using the Jadad scale and the quality of systematic reviews was assessed using criteria developed by the NHS Centre for Reviews and Dissemination. The quality of economic evaluation studies was assessed by their internal validity (i.e. the methods used) using a standard checklist, and external validity (i.e. the generalisability of the economic study to the population of interest) using a series of relevant questions. METHODS - DATA SYNTHESIS: The clinical effectiveness and cost-effectiveness of donepezil, rivastigmine and galantamine were synthesised through a narrative review with full tabulation of results of all included studies. In the economic evaluation, the reviewers assessed whether adjustments could be made to existing models to reflect the current situation in England and Wales. RESULTS - CLINICAL EFFECTIVENESS: (1) Donepezil--three systematic reviews and five RCTs (plus four studies from industry (unpublished data, submitted as commercial in confidence)) were found. Results suggest that donepezil is beneficial when assessed using global and cognitive outcome measures. (2) Rivastigmine--three systematic reviews and five RCTs (plus two studies from industry (unpublished data, submitted as commercial in confidence)) were found. Results suggest that rivastigmine is beneficial in terms of global outcome measures. (3) Galantamine--one systematic review and three RCTs (plus three studies from industry (unpublished data, submitted as commercial in confidence)) were found. Results suggest that galantamine is beneficial in terms of global, cognitive and functional scales. RESULTS - SUMMARY OF BENEFITS: It is difficult to quantify benefits from the evidence available in the literature. Statistically significant improvements in tests such as ADAS-cog (Alzheimer's Disease Assessment Scale cognitive subscale) may not be reflected in changes in daily life. (ABSTRACT TRUNCATED)"," Health Technol Assess. 2001;5(1):1-137. ","UK",2001,"Alzheimer’s","Donepezil,Galantamine,Rivastigmine",null,null,null,"Unclear"]
[118,"Foster GR, Scott DA, Payne S. The use of CT scanning in dementia.  A systematic review. Int J Technol Assess Health Care. 1999 Spring;15(2):406-23.","","Foster GR, Scott DA, Payne S."," The use of CT scanning in dementia.  A systematic review. ","While reversible cases of dementia are rare once detected, the patient may benefit from treatment. This paper examines the cost-effectiveness of computerized tomography (CT) scanning as a screening test for potentially reversible dementia. A systematic review was carried out to identify the proportion of patients with dementia above and below the age of 65 years with a theoretically treatable condition and the proportion of these patients who would benefit from neurosurgery. Information was combined with epidemiological and financial data relating to Scotland to model the costs and benefits of implementing a national screening program. Subdural hematoma, normal pressure hydrocephalus, and brain tumours are rare conditions treatable by neurosurgery. A scanning and treatment program for Scotland would cost 4.6 million Pounds per annum. Of 531 reversible cases detected, 136 would benefit from neurosurgery, 369 would not benefit, and 26 would die as a result of surgery. Treating normal pressure hydrocephalus reduces overall quality-adjusted survival. The most cost effective screening strategy is to scan all patients but treat only subdural hematomas, gaining 178 quality-adjusted life-years (QALYs) at a cost of 14,171 Pounds per QALY for patients aged 65 at the time of the scan. The corresponding figures for patients above and below 65 years are 9,000 Pounds and 23,000 Pounds, respectively. CT scanning appears cost-effective in dementia patients under 65 years. It should be undertaken selectively in more elderly patients. Surgical treatment of normal pressure hydrocephalus may reduce quality adjusted survival and should only be undertaken within clinical trials.","Int J Technol Assess Health Care. 1999 Spring;15(2):406-23.","UK",1999,null,"Diagnosis",null,null,null,"Cost-utility"]
[119,"Jönsson L, Lindgren P, Wimo A, Jönsson B, Winblad B. The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer's disease: a Markov model. Clin Ther. 1999 Jul;21(7):1230-40. ","doi: 10.1016/S0149-2918(00)80025-9. ","Jönsson L, Lindgren P, Wimo A, Jönsson B, Winblad B."," The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer's disease: a Markov model.","This study compared the cost-effectiveness of donepezil, a new cholinesterase inhibitor indicated for the treatment of mild-to-moderate probable Alzheimer's disease (AD), with no treatment. A Markov state transition model was employed to simulate treatment costs based on Swedish epidemiologic data. The Markov states used in the model were defined according to cognitive function, as assessed by the Mini-Mental State Examination. Data on costs and baseline transition probabilities were taken from the Kungsholmen Project, an observational, population-based study of persons aged >75 years in Sweden. Data on the treatment effect were taken from a clinical trial comparing donepezil to placebo over 24 weeks and were applied to the baseline transition probabilities to assess the effect of treating the clinical manifestations of AD in Swedish patients. Also, a within-trial analysis was performed for comparison, using transition probabilities taken from the clinical study. Both models were run for 5 years in half-year cycles, and both demonstrated various degrees of cost savings and improved effectiveness, as measured by increased time in nonsevere disease states. Thus donepezil had superior cost-effectiveness compared with no treatment."," Clin Ther. 1999 Jul;21(7):1230-40. ","Sweden",1999,"Alzheimer’s","Donepezil",null,null,null,"Unclear"]
[120,"Neumann PJ, Hermann RC, Kuntz KM, Araki SS, Duff SB, Leon J, Berenbaum PA, Goldman PA, Williams LW, Weinstein MC. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease. Neurology. 1999 Apr 12;52(6):1138-45. ","","Neumann PJ, Hermann RC, Kuntz KM, Araki SS, Duff SB, Leon J, Berenbaum PA, Goldman PA, Williams LW, Weinstein MC."," Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease.","To demonstrate the use of cost-effectiveness analysis to assess the economic impact of donepezil in the treatment of mild or moderate AD. Cost-effectiveness analyses show the relationship between resources used (costs) and health benefits achieved (effects) for an intervention compared with an alternative strategy. We developed a model to estimate the incremental cost-effectiveness of donepezil compared with no treatment. We determined costs per quality-adjusted life-years gained, a measurement that enhances the comparability of diverse studies. The model projects the progression of AD patients into more severe disease stages and into nursing homes. Data from a randomized clinical trial of donepezil were used to assess the drug's impact on the 6-week probabilities of progression. Data on the costs and health-related quality of life associated with different disease stages and settings were taken from published estimates and our companion cross-sectional study, respectively. Donepezil costs are partially offset by a reduction in the costs of care due to enhancement in cognitive functioning and the delay to more costly disease stages and settings. The magnitude of this cost offset and of the effect of donepezil on health-related quality of life depends on the model's assumptions about the duration of the drug effect, where controlled data are lacking. If the drug effect exceeds 2 years, the model predicts that for mild AD the drug would pay for itself in terms of cost offsets. The results of the cost-effectiveness model presented here suggest that donepezil may be cost-effective but additional controlled data on long-term drug efficacy are needed."," Neurology. 1999 Apr 12;52(6):1138-45. ","USA",1999,"Alzheimer’s","Donepezil",null,null,null,"Cost-utility"]
[121,"Ernst RL, Hay JW. Economic research on Alzheimer disease: a review of the literature. Alzheimer Dis Assoc Disord. 1997;11 Suppl 6():135-45.","","Ernst RL, Hay JW."," Economic research on Alzheimer disease: a review of the literature.","The present review discusses the economic research to date on Alzheimer disease (AD). It focuses on estimates of the costs of AD and on economic evaluations of interventions in the disease. Empirical and conceptual issues concerning the interpretation of costs and the uses of evaluative methodologies also are discussed. We conclude that estimates of the national costs of AD are open to a large margin of uncertainty. We conclude further that significant opportunities exist for new cost-effectiveness or cost-benefit analyses of AD treatments, patient care options, and counselling, respite, or similar programs for AD caregivers."," Alzheimer Dis Assoc Disord. 1997;11 Suppl 6():135-45.","International",1997,"Alzheimer’s","None or unclear",null,null,null,"Unclear"]
[122,"Wimo A, Mattsson B, Krakau I, Eriksson T, Nelvig A. Cost-effectiveness analysis of day care for patients with dementia disorders. Health Econ. 1994 Nov-Dec;3(6):395-404.","","Wimo A, Mattsson B, Krakau I, Eriksson T, Nelvig A."," Cost-effectiveness analysis of day care for patients with dementia disorders.","In a cost-effectiveness analysis, the costs of 55 demented patients in day care (DC) and 45 patients on a waiting list were related to the effects on indices measuring quality of life. Based on one year's study, the costs per patient per day, was USD 55 for the DC-group and USD 63 for the controls (p > 0.05). Both groups deteriorated in the indices during the study year. The trend was that DC was both cheaper and better in the indices, and some of the underlying variables for the used indices also showed significantly better results in favour of DC. However, since the changes between the groups were not significant regarding the basic question at issue, it cannot be stated that DC is more cost-effective than a care organisation without DC. Different interpretations of the results are presented."," Health Econ. 1994 Nov-Dec;3(6):395-404.","Sweden",1994,"Any dementia","Formal care",null,null,null,"Cost-utility"]
[123,"Neumann PJ, Hermann RC, Berenbaum PA, Weinstein MC. Methods of cost-effectiveness analysis in the assessment of new drugs for Alzheimer's disease. Psychiatr Serv. 1997 Nov;48(11):1440-4. ","doi: 10.1176/ps.48.11.1440.","Neumann PJ, Hermann RC, Berenbaum PA, Weinstein MC."," Methods of cost-effectiveness analysis in the assessment of new drugs for Alzheimer's disease.","New treatments for Alzheimer's disease highlight the complex clinical and financial issues at stake with new pharmacotherapies. This paper describes cost-effectiveness analysis as a method for assessing these issues. Cost-effectiveness analyses show the relationship between resources used and health benefits achieved for a medical intervention compared with an alternative strategy. In analyses of treatments of Alzheimer's disease, costs include health care resources, such as diagnostic tests, medications and efforts to monitor or treat side effects, acute hospital care, physicians' services, home health care, and nursing home care; non-health-care resources, such as support services provided by paid caregivers; and time spent by family members in unpaid provision of care and by patients in seeking care or undergoing an intervention. Effectiveness of interventions can be assessed by measuring changes in patients' cognitive functioning or by measuring years of life gained and the quality of life during those years. Cost-effectiveness studies often make use of disparate data sources, including data collected as part of randomized controlled clinical trials, and they often use mathematical models to support estimates. Because economic evaluations of new interventions for Alzheimer's disease will likely play an increasingly influential role in clinical and resource allocation in the coming years, physicians and other health system stakeholders should familiarize themselves with the techniques of cost-effectiveness analysis and become critical consumers of the literature describing these analyses."," Psychiatr Serv. 1997 Nov;48(11):1440-4. ","International",1997,"Alzheimer’s","None or unclear",null,null,null,"Unclear"]
[124,"Retchin SM, Hillner BE. The costs and benefits of a screening program to detect dementia in older drivers. Med Decis Making. 1994 Oct-Dec;14(4):315-24.","","Retchin SM, Hillner BE."," The costs and benefits of a screening program to detect dementia in older drivers.","A Markov model was used to assess the cost-benefit ratios of six strategies of screening older drivers for mental status, beginning at age 65. Probabilities of motor vehicle collisions (MVCs), injuries, and fatalities were obtained from national data. Dementia prevalence, test characteristics, and costs were obtained from the literature. Costs included lost wages, car ownership, alternative transportation, and injuries. Using a relative risk of MVC for those with dementia of 5 and a 5% annual discounting rate, the average cost per driver ranged from $51,600 (no testing) to $58,400 (testing every five years). The benefit was < one day of life gained, and the benefits of screening cost approximately 2.8 million dollars per life-year gained. Increasing the relative risk from 5 to 20 substantially improved the cost-benefit of mental status screening. However, mental status screening of older drivers would also be cost-beneficial if physician referral costs were lowered to $60 per evaluation. The authors conclude that a dementia screening program for older drivers would be cost-beneficial if physician evaluations were limited or their cost lowered to < or = $60."," Med Decis Making. 1994 Oct-Dec;14(4):315-24.","USA",1994,"Any dementia","Diagnosis",null,null,null,"Cost-effectiveness"]
[125,"Wimo A, Mattson B, Krakau I, Eriksson T, Nelvig A, Karlsson G. Cost-utility analysis of group living in dementia care. Int J Technol Assess Health Care. 1995 Winter;11(1):49-65. ","","Wimo A, Mattson B, Krakau I, Eriksson T, Nelvig A, Karlsson G."," Cost-utility analysis of group living in dementia care.","A cost-utility analysis (CUA) was applied to group living for dementia patients. A Markov-model of an expected life-length of 8 years was used. Forty-six patients in group living were compared to 39 patients living at home by inclusion and 23 institutionalized patients. When the cost per gained quality-adjusted life-year (QALY) was calculated, the group living alternative was the most favorable for the patients, giving a cost per paired QALY of US dollars < 0. In the extensive sensitivity analysis the main result was consistent but methodological problems were indicated."," Int J Technol Assess Health Care. 1995 Winter;11(1):49-65. ","USA",1995,"Any dementia","Formal care",null,null,null,"Cost-utility"]
[126,"Weinberger DR. Brain disease and psychiatric illness: when should a psychiatrist order a CAT scan? Am J Psychiatry. 1984 Dec;141(12):1521-7. ","doi: 10.1176/ajp.141.12.1521.","Weinberger DR."," Brain disease and psychiatric illness: when should a psychiatrist order a CAT scan? Am J Psychiatry.","Because psychiatric symptoms are frequently the earliest signs of CNS pathology, the author outlines the structural brain diseases that may underlie several psychiatric syndromes and describes the computerized axial tomographic (CAT) scan findings associated with those diseases. On the basis of an awareness of these conditions and a cost-benefit analysis, the following indications for CAT scanning of psychiatric patients are proposed: 1) confusion and/or dementia of unknown cause, 2) first episode of a psychosis of unknown etiology, 3) movement disorder of unknown etiology, 4) anorexia nervosa, 5) prolonged catatonia, and 6) first episode of major affective disorder or personality change after age 50."," 1984 Dec;141(12):1521-7. ","Unknown",1984,"Any dementia","Diagnosis",null,null,null,"Cost-benefit"]
[127,"Engedal K. Day care for demented patients in general nursing homes.  Effects on admissions to institutions and mental capacity. Scand J Prim Health Care. 1989 Oct;7(3):161-6. ","","Engedal K."," Day care for demented patients in general nursing homes.  Effects on admissions to institutions and mental capacity. ","A day centre programme for demented patients aged 75 years and over was evaluated in a controlled trial, emphasizing its effect on the use of institutional care and mental capacity. A cost-benefit analysis of the programme was also performed. Thirty-eight patients were offered day care, thirty-nine served as controls. The programme was cost-effective in the sense that it reduced the frequency of the admissions to the acute units of the City hospitals and the cost of care. However, admission to permanent stay in nursing home was not delayed. The mental capacity deteriorated at the same rate in the two groups.","Scand J Prim Health Care. 1989 Oct;7(3):161-6. ","Unknown",1989,"Any dementia","Formal care",null,null,null,"Unclear"]
[128,"Geldmacher DS. The cost benefit to health plans of pharmacotherapy for Alzheimer's disease. Manag Care. 2005 Dec;14(12):44-6, 49-52, 54-5. d","","Geldmacher DS."," The cost benefit to health plans of pharmacotherapy for Alzheimer's disease.","Treatment of Alzheimer's disease (AD) is a major public health issue, with the potential for significant impact on MCOs. As the number of people affected with AD continues to rise, the importance of this problem will grow as well. This article reviews patient and caregiver outcomes associated with reduced health care costs and their implications for MCOs. Cholinesterase inhibitors (ChEIs) are effective in treating cognitive, functional, and behavioral symptoms for patients with mild to moderate and moderate to severe AD. Treatment with memantine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to benefit patients with moderate to severe AD. Pharmacoeconomic studies indicate that donepezil and memantine treatment may reduce total costs of care for AD patients and their caregivers, with potential economic benefits to MCOs."," Manag Care. 2005 Dec;14(12):44-6, 49-52, 54-5. d","International",2005,"Alzheimer’s","Any anticholinesterase,Donepezil,Memantine",null,null,null,"Unclear"]
[129,"McMahon PM, Araki SS, Neumann PJ, Harris GJ, Gazelle GS. Cost-effectiveness of functional imaging tests in the diagnosis of Alzheimer disease. Radiology. 2000 Oct;217(1):58-68. ","doi: 10.1148/radiology.217.1.r00se1358.","McMahon PM, Araki SS, Neumann PJ, Harris GJ, Gazelle GS."," Cost-effectiveness of functional imaging tests in the diagnosis of Alzheimer disease.","To evaluate the cost-effectiveness of functional neuroimaging in the work-up of patients at specialized Alzheimer disease clinics. A decision model was used to calculate costs and benefits (in quality-adjusted life-years [QALYs]) that accrued to hypothetical cohorts of patients at presentation to an Alzheimer disease center. Sensitivity analysis was performed to examine the effects of diagnostic test characteristics, therapeutic efficacy, disease severity, and costs on cost-effectiveness. The incremental cost-effectiveness ratio of dynamic susceptibility contrast material-enhanced magnetic resonance (MR) imaging was $479,500 per QALY (compared with the usual diagnostic work-up), while visual or quantitative single photon emission computed tomography (SPECT) was dominated (higher costs, lower effectiveness) by the usual diagnostic work-up. These results depend critically on the sensitivity and specificity of the standard diagnostic work-up, the effectiveness of drug treatment, and the disease severity. Varying these parameters resulted in estimates of incremental cost-effectiveness for dynamic susceptibility contrast-enhanced MR imaging of $24,680 to $8.6 million per QALY. SPECT either was dominated by the usual diagnostic work-up or had cost-effectiveness ratios of $180,200 to $6 million per QALY. The addition of functional neuroimaging to the usual diagnostic regimen at Alzheimer disease clinics is not cost-effective given the effectiveness of currently available therapies."," Radiology. 2000 Oct;217(1):58-68. ","USA",2000,"Alzheimer’s","Diagnosis",null,null,null,"Cost-utility"]
[130,"Busschbach JJ, Brouwer WB, van der Donk A, Passchier J, Rutten FF. An outline for a cost-effectiveness analysis of a drug for patients with Alzheimer's disease. Pharmacoeconomics. 1998 Jan;13(1 Pt 1):21-34","","Busschbach JJ, Brouwer WB, van der Donk A, Passchier J, Rutten FF."," An outline for a cost-effectiveness analysis of a drug for patients with Alzheimer's disease.","This article provides an outline for a cost-effectiveness analysis of a drug that slows the consequences of Alzheimer's disease. Such an analysis cannot easily be performed for 2 main reasons. The first is that often relatives and friends, rather than professionals, take care of the patient. This means that informal care plays an important role in the analysis. However, consensus on how to value informal care is lacking. In this article, we have recommended the shadow-price method because this is an option that can be practically applied. The second reason is that the primary source of information on quality of life, the patients themselves, is unreliable because of cognitive disturbances. The solution is to ask 'significant others' to indicate quality of life instead of the patient. As well as measuring the patient's quality of life, the quality of life of the informal caregiver is also often measured. This is recommended here, but as a separate item in the analysis. In this way, double-counting in the final cost-effectiveness ratio can be avoided. Several instruments for measuring a patient's and caregiver's quality of life are discussed and recommendations about suitable methods are made."," Pharmacoeconomics. 1998 Jan;13(1 Pt 1):21-34","Netherlands",1998,"Alzheimer’s","None or unclear",null,null,null,"Cost-utility"]
[131,"Vlietinck R, Van Loon H, Van de Broele H, Tormans G. Retrospective estimate of the nursing cost of autonomy impairment and cost benefit in clinical trials: feasibility and application of piracetam in demented elderly patients. Adv Ther. 1993 Sep-Oct;10(5):226-44.","","Vlietinck R, Van Loon H, Van de Broele H, Tormans G."," Retrospective estimate of the nursing cost of autonomy impairment and cost benefit in clinical trials: feasibility and application of piracetam in demented elderly patients.","The aims of this study were to determine whether the nursing costs of functional disability could be assessed retrospectively and, if so, whether this method was sensitive enough to show the influence of a treatment on economic costs. Four studies were available for this purpose: three randomized, double-blind, placebo-controlled, clinical trials measuring, among others, the influence of piracetam on activities of daily living (ADL) of elderly demented patients in Italy, Austria, and Belgium, and one large population-based survey measuring the costs of providing basic nursing, hygienic, and therapeutic needs to 6000 elderly according to ADL scores. The items on the different ADL scales used in each trial were recoded to a common denominator, and an overall dependency score was calculated for each patient. The survey data showed a highly significant linear correlation between ADL status and nursing expenses. Nursing costs of noninstitutionalized patients were calculated by assigning each patient the average nursing cost of all persons from the survey who matched by sex, age, and dependency score. Retrospective economic assessment was possible for ambulatory patients when there were functional assessments and a survey with nursing costs gauged according to those functional assessments. Objective classification criteria for hospital or retirement home patients are needed for the level of reimbursement of nursing costs. Piracetam treatment decreased dependency, compared with placebo. The economic improvement continued over the entire duration of all three clinical trials, lasting up to 6 months in the Italian trial in both ambulatory and residential settings. The decrease in nursing costs remained stable during the same period for patients treated with piracetam, whereas nursing costs of placebo patients steadily increased. After 6 months this difference increased a monthly average of 820 Belgian francs (BF {35 BF = 1 US $}) for ambulatory patients in favor of piracetam, 1650 BF for residential patients, and 2580 BF for hospitalized individuals."," Adv Ther. 1993 Sep-Oct;10(5):226-44.","Belgium",1993,"Any dementia","Formal care",null,null,null,"Cost-benefit"]

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[1,"Woods RT,Orrell M,Bruce E,Edwards RT,Hoare Z,Hounsome B,Keady J,Moniz-Cook E,Orgeta V,Rees J,Russell I. REMCARE: Pragmatic Multi-Centre Randomised Trial of Reminiscence Groups for People with Dementia and their Family Carers: Effectiveness and Economic Analysis. PLoS One. 2016;11(4):e0152843. ","doi: 10.1371/journal.pone.0152843. ","Woods RT,Orrell M,Bruce E,Edwards RT,Hoare Z,Hounsome B,Keady J,Moniz-Cook E,Orgeta V,Rees J,Russell I."," REMCARE: Pragmatic Multi-Centre Randomised Trial of Reminiscence Groups for People with Dementia and their Family Carers: Effectiveness and Economic Analysis.","Joint reminiscence groups,involving people with dementia and family carers together,are popular,but the evidence-base is limited. This study aimed to assess the effectiveness and cost-effectiveness of joint reminiscence groups as compared to usual care. This multi-centre,pragmatic randomised controlled trial had two parallel arms: intervention group and usual-care control group. A restricted dynamic method of randomisation was used,with an overall allocation ratio of 1:1,restricted to ensure viable sized intervention groups. Assessments,blind to treatment allocation,were carried out at baseline,three months and ten months (primary end-point),usually in the person's home. Participants were recruited in eight centres,mainly through NHS Memory Clinics and NHS community mental health teams. Included participants were community resident people with mild to moderate dementia (DSM-IV),who had a relative or other care-giver in regular contact,to act as informant and willing and able to participate in intervention. 71% carers were spouses. 488 people with dementia (mean age 77.5)were randomised: 268 intervention,220 control; 350 dyads completed the study (206 intervention,144 control). The intervention evaluated was joint reminiscence groups (with up to 12 dyads) weekly for twelve weeks; monthly maintenance sessions for further seven months. Sessions followed a published treatment manual and were held in a variety of community settings. Two trained facilitators in each centre were supported by volunteers. Primary outcome measures were self-reported quality of life for the person with dementia (QoL-AD),psychological distress for the carer (General Health Questionnaire,GHQ-28). Secondary outcome measures included: autobiographical memory and activities of daily living for the person with dementia; carer stress for the carer; mood,relationship quality and service use and costs for both. The intention to treat analysis (ANCOVA) identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes (self-reported QoL-AD mean difference 0.07 (-1.21 to 1.35),F = 0.48,p = 0.53). Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a General Health Questionnaire-28 sub-scale at the ten month end-point (mean difference 1.25 (0.25 to 2.26),F = 8.28,p = 0.04). Compliance analyses suggested improved autobiographical memory,quality of life and relationship quality for people with dementia attending more reminiscence sessions,however carers attending more groups showed increased care-giving stress. Economic analyses from a public sector perspective indicated that joint reminiscence groups are unlikely to be cost-effective. There were no significant adverse effects attributed to the intervention. Potential limitations of the study include less than optimal attendance at the group sessions--only 57% of participants attended at least half of the intervention sessions over the 10 month period,and a higher rate of study withdrawal in the control group. This trial does not support the clinical effectiveness or cost-effectiveness of joint reminiscence groups. Possible beneficial effects for people with dementia who attend sessions as planned are offset by raised anxiety and stress in their carers. The reasons for these discrepant outcomes need to be explored further,and may necessitate reappraisal of the movement towards joint interventions. ISRCTN Registry ISRCTN42430123."," PLoS One. 2016;11(4):e0152843. ","UK",2016,"Any dementia","Other psychological therapies",null,null,null,"Unclear",null,"UK",null,"Any dementia","Other psychological therapies","Unclear",null,null,"2015:2017"]
[2,"Hindle JV,Watermeyer TJ,Roberts J,Martyr A,Lloyd-Williams H,Brand A,Gutting P,Hoare Z,Edwards RT,Clare L. Cognitive rehabiliation for Parkinson's disease demantia: a study protocol for a pilot randomised controlled trial. Trials. 2016 Mar 22;17():152. ","doi: 10.1186/s13063-016-1253-0. ","Hindle JV,Watermeyer TJ,Roberts J,Martyr A,Lloyd-Williams H,Brand A,Gutting P,Hoare Z,Edwards RT,Clare L."," Cognitive rehabiliation for Parkinson's disease demantia: a study protocol for a pilot randomised controlled trial.","There is growing interest in developing non-pharmacological treatments to address the cognitive deficits apparent in Parkinson's disease dementia and dementia with Lewy bodies. Cognitive rehabilitation is a goal-oriented behavioural intervention which focuses on improving everyday functioning through management of cognitive difficulties; it has been shown to be effective in Alzheimer's disease. To date,no studies have assessed its potential efficacy for addressing the impact of cognitive impairment in people with Parkinson's disease or dementia with Lewy bodies. Participants (n = 45) will be recruited from movement disorders,care for the elderly and memory clinics. Inclusion criteria include: a diagnosis of Parkinson's disease,Parkinson's disease dementia or dementia with Lewy bodies according to consensus criteria and an Addenbrooke's Cognitive Examination - III score of ≤ 82. Exclusion criteria include: a diagnosis of any other significant neurological condition; major psychiatric disorder,including depression,which is not related to the patient's Parkinson's disease and unstable medication use for their physical or cognitive symptoms. A single-blind pilot randomised controlled trial,with concurrent economic evaluation,will compare the relative efficacy of cognitive rehabilitation with that of two control conditions. Following a goal-setting interview,the participants will be randomised to one of the three study arms: cognitive rehabilitation (eight weekly sessions),relaxation therapy (eight weekly sessions) or treatment as usual. Randomisation and treatment group allocation will be carried out by a clinical trials unit using a dynamic adaptive sequential randomisation algorithm. The primary outcomes are patients' perceived goal attainment at a 2-months post-intervention assessment and a 6-months follow-up. Secondary outcomes include patients' objective cognitive performance (on tests of memory and executive function) and satisfaction with goal attainment,carers' perception of patients' goal attainment and patients' and carers' health status and psychosocial well-being,measured at the same time points. Cost-effectiveness will be examined to explore the design of a larger cost-effectiveness analysis alongside a full trial. This pilot study will evaluate the application of cognitive rehabilitation for the management of cognitive difficulties associated with Parkinson's disease dementia and dementia with Lewy bodies. The results of the study will inform the design of a fully powered randomised controlled trial. ISRCTN16584442 DOI 10.1186/ISRCTN16584442 13 April 2015."," Trials. 2016 Mar 22;17():152. ","UK",2016,"Lewy body dementia,Parkinson’s dementia","Cognitive therapies",null,null,null,"Unclear",null,"UK",null,"Lewy body dementia,Parkinson’s dementia","Cognitive therapies","Unclear",null,null,"2015:2017"]
[3,"Orgeta V,Leung P,Yates L,Kang S,Hoare Z,Henderson C,Whitaker C,Burns A,Knapp M,Leroi I,Moniz-Cook ED,Pearson S,Simpson S,Spector A,Roberts S,Russell IT,de Waal H,Woods RT,Orrell M. Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic,multicentre,randomised controlled trial. Health Technol Assess. 2015 Aug;19(64):1-108. ","doi: 10.3310/hta19640. ","Orgeta V,Leung P,Yates L,Kang S,Hoare Z,Henderson C,Whitaker C,Burns A,Knapp M,Leroi I,Moniz-Cook ED,Pearson S,Simpson S,Spector A,Roberts S,Russell IT,de Waal H,Woods RT,Orrell M."," Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic,multicentre,randomised controlled trial.","Group cognitive stimulation therapy programmes can benefit cognition and quality of life for people with dementia. Evidence for home-based,carer-led cognitive stimulation interventions is limited. To evaluate the clinical effectiveness and cost-effectiveness of carer-delivered individual cognitive stimulation therapy (iCST) for people with dementia and their family carers,compared with treatment as usual (TAU). A multicentre,single-blind,randomised controlled trial assessing clinical effectiveness and cost-effectiveness. Assessments were at baseline,13 weeks and 26 weeks (primary end point). Participants were recruited through Memory Clinics and Community Mental Health Teams for older people. A total of 356 caregiving dyads were recruited and 273 completed the trial. iCST consisted of structured cognitive stimulation sessions for people with dementia,completed up to three times weekly over 25 weeks. Family carers were supported to deliver the sessions at home. Primary outcomes for the person with dementia were cognition and quality of life. Secondary outcomes included behavioural and psychological symptoms,activities of daily living,depressive symptoms and relationship quality. The primary outcome for the family carers was mental/physical health (Short Form questionnaire-12 items). Health-related quality of life (European Quality of Life-5 Dimensions),mood symptoms,resilience and relationship quality comprised the secondary outcomes. Costs were estimated from health and social care and societal perspectives. There were no differences in any of the primary outcomes for people with dementia between intervention and TAU [cognition: mean difference -0.55,95% confidence interval (CI) -2.00 to 0.90; p-value = 0.45; self-reported quality of life: mean difference -0.02,95% CI -1.22 to 0.82; p-value = 0.97 at the 6-month follow-up]. iCST did not improve mental/physical health for carers. People with dementia in the iCST group experienced better relationship quality with their carer,but there was no evidence that iCST improved their activities of daily living,depression or behavioural and psychological symptoms. iCST seemed to improve health-related quality of life for carers but did not benefit carers' resilience or their relationship quality with their relative. Carers conducting more sessions had fewer depressive symptoms. Qualitative data suggested that people with dementia and their carers experienced better communication owing to iCST. Adjusted mean costs were not significantly different between the groups. From the societal perspective,both health gains and cost savings were observed. iCST did not improve cognition or quality of life for people with dementia,or carers' physical and mental health. Costs of the intervention were offset by some reductions in social care and other services. Although there was some evidence of improvement in terms of the caregiving relationship and carers' health-related quality of life,iCST does not appear to deliver clinical benefits for cognition and quality of life for people with dementia. Most people received fewer than the recommended number of iCST sessions. Further research is needed to ascertain the clinical effectiveness of carer-led cognitive stimulation interventions for people with dementia. Current Controlled Trials ISRCTN65945963. "," Health Technol Assess. 2015 Aug;19(64):1-108. ","UK",2015,"Any dementia","Cognitive therapies",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Cognitive therapies","Cost-utility",null,null,"2015:2017"]
[4,"Mirsaeedi-Farahani K,Halpern CH,Baltuch GH,Wolk DA,Stein SC. Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis. J Neurol. 2015 May;262(5):1191-7. ","doi: 10.1007/s00415-015-7688-5. ","Mirsaeedi-Farahani K,Halpern CH,Baltuch GH,Wolk DA,Stein SC."," Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis.","Alzheimer disease (AD) is characterized by impairments in memory function. Standard AD treatment provides marginal improvements in this domain. Recent reports,however,suggested that deep brain stimulation (DBS) may result in improved memory. Given significant equipment costs and health expenses required for DBS surgery,we determine clinical and economic thresholds required for it to be as effective as standard AD treatment. Literature review yielded annual AD progression probabilities,health-related quality of life (QoL),and costs by AD stage. Our 5-year decision analysis model compared cumulative QoL in quality-adjusted life years (QALYs) and costs of standard therapy to theoretical DBS treatment of various success rates,using known complication rates and QoL data. The base case was a patient with mild-stage AD. DBS success was defined as regression to and maintenance of minimal stage AD,which was defined as midway between mild and no dementia,for the first year,and continuation of the natural course of AD for the remaining 4 years. Compared to standard treatment alone,DBS for mild-stage AD requires a success rate of 3% to overcome effects of possible surgical complications on QoL. If DBS can be delivered with success rates above 20% ($200 K/QALY) or 74% ($50 K/QALY) for mild AD,it can be considered cost-effective. Above a success rate of 80%,DBS treatment is both clinically more effective and more cost-effective than standard treatment. Our findings demonstrate that clinical and economic thresholds required for DBS to be cost-effective for AD are relatively low."," J Neurol. 2015 May;262(5):1191-7. ","USA",2015,"Alzheimer’s","Deep brain stimulation",null,null,null,"Cost-utility",null,"USA",null,"Alzheimer’s","Deep brain stimulation","Cost-utility",null,null,"2015:2017"]
[5,"D'Amico F,Rehill A,Knapp M,Aguirre E,Donovan H,Hoare Z,Hoe J,Russell I,Spector A,Streater A,Whitaker C,Woods RT,Orrell M. Maintenance cognitive stimulation therapy: an economic evaluation within a randomized controlled trial. J Am Med Dir Assoc. 2015 Jan;16(1):63-70. ","doi: 10.1016/j.jamda.2014.10.020. ","D'Amico F,Rehill A,Knapp M,Aguirre E,Donovan H,Hoare Z,Hoe J,Russell I,Spector A,Streater A,Whitaker C,Woods RT,Orrell M."," Maintenance cognitive stimulation therapy: an economic evaluation within a randomized controlled trial.","Cognitive Stimulation Therapy (CST) is effective and cost-effective for people with mild-to-moderate dementia when delivered biweekly over 7 weeks. To examine whether longer-term (maintenance) CST is cost-effective when added to usual care. Cost-effectiveness analysis within multicenter,single-blind,pragmatic randomized controlled trial; subgroup analysis for people taking acetylcholinesterase inhibitors (ACHEIs). A total of 236 participants with mild-to-moderate dementia received CST for 7 weeks. They were randomized to either weekly maintenance CST added to usual care or usual care alone for 24 weeks. Although outcome gains were modest over 6 months,maintenance CST appeared cost-effective when looking at self-rated quality of life as primary outcome,and cognition (MMSE) and proxy-rated quality-adjusted life years as secondary outcomes. CST in combination with ACHEIs offered cost-effectiveness gains when outcome was measured as cognition. Continuation of CST is likely to be cost-effective for people with mild-to-moderate dementia."," J Am Med Dir Assoc. 2015 Jan;16(1):63-70. ","UK",2015,"Any dementia","Cognitive therapies",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Cognitive therapies","Cost-utility",null,null,"2015:2017"]
[6,"Livingston G,Barber J,Rapaport P,Knapp M,Griffin M,Romeo R,King D,Livingston D,Lewis-Holmes E,Mummery C,Walker Z,Hoe J,Cooper C. START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia. Health Technol Assess. 2014 Oct;18(61):1-242. ","doi: 10.3310/hta18610.","Livingston G,Barber J,Rapaport P,Knapp M,Griffin M,Romeo R,King D,Livingston D,Lewis-Holmes E,Mummery C,Walker Z,Hoe J,Cooper C."," START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia.","Two-thirds of people with dementia live at home,receiving most care from family carers,about 40% of whom have clinically significant depression or anxiety. This impacts on the person with dementia,families and society,predicting care breakdown. There are currently no clinically effective and cost-effective NHS family carer interventions. To assess the STrAtegies for RelaTives (START) intervention in the short (4 and 8 months) and long term (1 and 2 years) compared with treatment as usual (TAU). Randomised,parallel-group,superiority trial with blinded assessment recruiting participants 2:1 (intervention to TAU) to allow for therapist clustering. Three UK mental health services and one neurological service. Family carers of people with dementia. Eight-session manual-based coping intervention delivered by supervised psychology graduates to individuals. Affective symptoms [Hospital Anxiety and Depression Scale-total (HADS-T)] and cost-effectiveness. Secondary measures: anxiety and depression symptoms and caseness,quality of life (QoL),abusive behaviour and long-term care home admission. Two hundred and sixty participants were randomised (173 intervention,87 TAU). We used intention-to-treat analysis in the short term (152 intervention,77 TAU) and in the long term (140 intervention,69 TAU). In the short term,the intervention group had lower HADS-T [mean difference -1.80,95% confidence interval (CI) -3.29 to -0.31; p=0.02] and higher quality-adjusted life-years (QALYs) (mean difference 0.03,95% CI -0.01 to 0.08). Costs were no different between groups [mean £ 252 (95% CI -£ 28 to £ 565) for intervention group]. The cost-effectiveness acceptability curve showed a greater than 99% chance of being cost-effectiveness at a £ 30,000/QALY willingness-to-pay threshold and a high probability of cost-effectiveness based on the HADS-T score. Carers in the intervention group had less case-level depression [odds ratio (OR) 0.24,95% CI 0.07 to 0.76],a trend towards reduced case-level anxiety (OR 0.30,95% CI 0.08 to 1.05),lower Hospital Anxiety and Depression Scale-anxiety (HADS-A) (-0.91,95% CI -1.76 to -0.07; p = 0.03) and Hospital Anxiety and Depression Scale-depression (HADS-D) (-0.91,95% CI -1.71 to -0.10; p = 0.03) and higher Health Status Questionnaire (HSQ) QoL (mean difference 4.09,95% CI 0.34 to 7.83). Group differences in abusive behaviour (OR 0.48,95% CI 0.18 to 1.27) and the person with dementia's quality of life-Alzheimer's disease (QoL-AD) (mean increase 0.59,95% CI -0.72 to 1.89) were not significant. In the long term,the intervention group had lower HADS-T (mean difference -2.58,95% CI -4.26 to -0.90; p = 0.03) and higher QALYs (mean difference 0.03,95% CI -0.01 to 0.06). Carers in the intervention group had less case-level depression (OR 0.14,95% CI 0.04 to 0.53),a trend towards reduced case-level anxiety (OR 0.57,95% CI 0.26 to 1.24),lower HADS-A (-1.16,95% CI -2.15 to -0.18) and HADS-D (1.45,95% CI -2.32 to -0.57),and higher HSQ (mean difference 7.47,95% CI 2.87 to 12.08). Thirty-two (18.7%) people with dementia in the intervention group and 17 (20.2%) in TAU were admitted to a care home (hazard ratio 0.83,95% CI 0.44 to 1.56; p = 0.56). There were no significant differences between groups in abusive behaviour (OR 0.83,95% CI 0.36 to 1.94),the person with dementia's QoL-AD (0.17,95% CI -1.37 to 1.70) or costs (£ 336,95% CI -£ 223 to £ 895) for intervention group. The probability that the intervention would be seen as cost-effective at £ 30,000/QALY threshold and cost-effectiveness on the HADS-T remained high. The START intervention was clinically effective and cost-effective in the short and longer term. The results are robust to the sensitivity analyses performed. Future work is needed to consider mechanism of action; the effects on people with dementia in clinical terms (cognition,neuropsychiatric symptoms,longer-term care home admission); and on health and social care costs. In addition,we will explore the effects of carer abusive behaviour on the care recipient's care home admission and if this then reduces abusive behaviour. We would also like to implement START and evaluate this implementation in clinical practice. Current Controlled Trials ISCTRN70017938."," Health Technol Assess. 2014 Oct;18(61):1-242. ","UK",2014,"Any dementia","Support",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Support","Cost-utility",null,null,"2010:2014"]
[7,"Wouters H,Quik EH,Boersma F,Nygård P,Bosman J,Böttger WM,Mulder H,Maring JG,Wijma-Vos L,Beerden T,van Doormaal J,Postma MJ,Zuidema SU,Taxis K. Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial. BMJ Open. 2014 Oct 8;4(10):e006082. ","doi: 10.1136/bmjopen-2014-006082.","Wouters H,Quik EH,Boersma F,Nygård P,Bosman J,Böttger WM,Mulder H,Maring JG,Wijma-Vos L,Beerden T,van Doormaal J,Postma MJ,Zuidema SU,Taxis K."," Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial.","Nursing home residents often have a high number of comorbidities resulting in polypharmacy. Inappropriate prescribing is therefore likely to occur,which in turn is expected to worsen cognitive impairment,to increase the fall risk and to decrease residents' quality of life. The objective of the 'Discontinuing Inappropriate Medication in Nursing Home Residents' (DIM-NHR) study is to examine the efficacy and cost-effectiveness of the Multidisciplinary Multistep Medication Review (3MR) that is aimed at optimising prescribing and discontinuing inappropriate medication. A cluster randomised controlled trial will be conducted. Elderly care physicians and their wards (clusters) will be randomised. Data will be collected at baseline and 4 months after the 3MR has taken place. Six hundred nursing home residents will be recruited of whom more than half are expected to suffer from dementia. The 3MR will be based on consensus criteria and the relevant literature and will be performed by the patient's elderly care physician in collaboration with a pharmacist. Primary outcomes-the difference in proportion of residents who successfully discontinued inappropriate medication between the intervention and control group at follow-up. Secondary outcomes-undertreatment,exposure to anticholinergic and sedative medicines,neuropsychiatric symptoms,cognitive function,falls,hospital admission,quality of life and cost-effectiveness. Participant burden will be kept at a minimum. The elderly care physician will remain free to adjust medication when symptoms relapse or adverse events occur,rendering serious adverse events highly unlikely. Study findings will be published in peer-reviewed journals and a 3MR toolkit will be developed. This study has been registered at http://www.ClinicalTrials.gov (trial registration number: NCT01876095)."," BMJ Open. 2014 Oct 8;4(10):e006082. ","Netherlands",2014,"Any dementia","Disease management",null,null,null,"Unclear",null,"Netherlands",null,"Any dementia","Disease management","Unclear",null,null,"2010:2014"]
[8,"Versijpt J. Effectiveness and cost-effectiveness of the pharmacological treatment of Alzheimer's disease and vascular dementia. J Alzheimers Dis. 2014;42 Suppl 3():S19-25. ","doi: 10.3233/JAD-132639. ","Versijpt J."," Effectiveness and cost-effectiveness of the pharmacological treatment of Alzheimer's disease and vascular dementia.","Until an effective and especially disease-modifying treatment for Alzheimer's disease (AD) and vascular dementia (VaD) is available,the currently available pharmacological therapeutic arsenal aims at merely improving symptomatology. Health economic data make an important contribution to the planning of healthcare services and the estimation of the cost of drug reimbursement. As such,both for cholinesterase inhibitors and,to a lesser extent,for memantine it can be claimed that the direct cost of the drug itself is eclipsed by the cost savings associated with delaying institutionalization or delaying the time of progression into a more severe disease state. The present manuscript reviews several factors contributing to the costs of dementia,gives an overview of available studies claiming both the effectiveness and cost-effectiveness of current dementia treatments,and highlights strengths and weaknesses of the aforementioned studies."," J Alzheimers Dis. 2014;42 Suppl 3():S19-25. ","International",2014,"Alzheimer’s,Vascular dementia","Any anticholinesterase",null,null,null,"Unclear",null,"International",null,"Alzheimer’s,Vascular dementia","Any anticholinesterase","Unclear",null,null,"2010:2014"]
[9,"Livingston G,Kelly L,Lewis-Holmes E,Baio G,Morris S,Patel N,Omar RZ,Katona C,Cooper C. A systematic review of the clinical effectiveness and cost-effectiveness of sensory,psychological and behavioural interventions for managing agitation in older adults with dementia. Health Technol Assess. 2014 Jun;18(39):1-226,v-vi. ","doi: 10.3310/hta18390. ","Livingston G,Kelly L,Lewis-Holmes E,Baio G,Morris S,Patel N,Omar RZ,Katona C,Cooper C."," A systematic review of the clinical effectiveness and cost-effectiveness of sensory,psychological and behavioural interventions for managing agitation in older adults with dementia.","Agitation is common,persistent and distressing in dementia and is linked with care breakdown. Psychotropic medication is often ineffective or harmful,but the evidence regarding non-pharmacological interventions is unclear. We systematically reviewed and synthesised the evidence for clinical effectiveness and cost-effectiveness of non-pharmacological interventions for reducing agitation in dementia,considering dementia severity,the setting,the person with whom the intervention is implemented,whether the effects are immediate or longer term,and cost-effectiveness. We searched twice using relevant search terms (9 August 2011 and 12 June 2012) in Web of Knowledge (incorporating MEDLINE); EMBASE; British Nursing Index; the Health Technology Assessment programme database; PsycINFO; NHS Evidence; System for Information on Grey Literature; The Stationery Office Official Documents website; The Stationery National Technical Information Service; Cumulative Index to Nursing and Allied Health Literature; and The Cochrane Library. We also searched Cochrane reviews of interventions for behaviour in dementia,included papers' references,and contacted authors about 'missed' studies. We included quantitative studies,evaluating non-pharmacological interventions for agitation in dementia,in all settings. We rated quality,prioritising higher-quality studies. We separated results by intervention type and agitation level. As we were unable to meta-analyse results except for light therapy,we present a qualitative evidence synthesis. In addition,we calculated standardised effect sizes (SESs) with available data,to compare heterogeneous interventions. In the health economic analysis,we reviewed economic studies,calculated the cost of effective interventions from the effectiveness review,calculated the incremental cost per unit improvement in agitation,used data from a cohort study to evaluate the relationship between health and social care costs and health-related quality of life (DEMQOL-Proxy-U scores) and developed a new cost-effectiveness model. We included 160 out of 1916 papers screened. Supervised person-centred care,communication skills (SES = -1.8 to -0.3) or modified dementia care mapping (DCM) with implementing plans (SES = -1.4 to -0.6) were all efficacious at reducing clinically significant agitation in care home residents,both immediately and up to 6 months afterwards. In care home residents,during interventions but not at follow-up,activities (SES = -0.8 to -0.6) and music therapy (SES = -0.8 to -0.5) by protocol reduced mean levels of agitation; sensory intervention (SES = -1.3 to -0.6) reduced mean and clinically significant symptoms. Advantages were not demonstrated with 'therapeutic touch' or individualised activity. Aromatherapy and light therapy did not show clinical effectiveness. Training family carers in behavioural or cognitive interventions did not decrease severe agitation. The few studies reporting activities of daily living or quality-of-life outcomes found no improvement,even when agitation had improved. We identified two health economic studies. Costs of interventions which significantly impacted on agitation were activities,£80-696; music therapy,£13-27; sensory interventions,£3-527; and training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM,£31-339. Among the 11 interventions that were evaluated using the Cohen-Mansfield Agitation Inventory (CMAI),the incremental cost per unit reduction in CMAI score ranged from £162 to £3480 for activities,£4 for music therapy,£24 to £143 for sensory interventions,and £6 to £62 for training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM. Health and social care costs ranged from around £7000 over 3 months in people without clinically significant agitation symptoms to around £15,000 at the most severe agitation levels. There is some evidence that DEMQOL-Proxy-U scores decline with Neuropsychiatric Inventory agitation scores. A multicomponent intervention in participants with mild to moderate dementia had a positive monetary net benefit and a 82.2% probability of being cost-effective at a maximum willingness to pay for a quality-adjusted life-year of £20,000 and a 83.18% probability at a value of £30,000. Although there were some high-quality studies,there were only 33 reasonably sized (> 45 participants) randomised controlled trials,and lack of evidence means that we cannot comment on many interventions' effectiveness. There were no hospital studies and few studies in people's homes. More health economic data are needed. Person-centred care,communication skills and DCM (all with supervision),sensory therapy activities,and structured music therapies reduce agitation in care-home dementia residents. Future interventions should change care home culture through staff training and permanently implement evidence-based treatments and evaluate health economics. There is a need for further work on interventions for agitation in people with dementia living in their own homes. The study was registered as PROSPERO no. CRD42011001370."," Health Technol Assess. 2014 Jun;18(39):1-226,v-vi. ","UK",2014,"Any dementia","Behavioural therapies,Cognitive therapies,Other psychological therapies",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Behavioural therapies,Cognitive therapies,Other psychological therapies","Cost-utility",null,null,"2010:2014"]
[10,"Fowler NR,Harrawood A,Frame A,Perkins AJ,Gao S,Callahan CM,Sachs GA,French DD,Boustani MA. The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of dementia screening (CHOICE) study: study protocol for a randomized controlled trial. Trials. 2014 Jun 6;15():209. ","doi: 10.1186/1745-6215-15-209.","Fowler NR,Harrawood A,Frame A,Perkins AJ,Gao S,Callahan CM,Sachs GA,French DD,Boustani MA."," The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of dementia screening (CHOICE) study: study protocol for a randomized controlled trial.","Dementia affects over 4 million people in the US and is frequently unrecognized and underdiagnosed in primary care. Routine dementia screening in primary care is not recommended by the US Preventive Services Task Force due to lack of empirical data on the benefits and harms of screening. This trial seeks to fill this gap and contribute information about the benefits,harms,and costs of routine screening for dementia in primary care. Single-blinded,parallel,randomized controlled clinical trial with 1:1 allocation. A total of 4,000 individuals aged ≥65 years without a diagnosis of dementia,cognitive impairment,or serious mental illness receiving care at primary care practices within two cities in Indiana. Subjects will be randomized to either i) screening for dementia using the Memory Impairment Screen Telephone version or ii) no screening for dementia. Subjects who screen positive for dementia will be referred to the local Aging Brain Care program that delivers an evidence-based collaborative care model for dementia and depression. Research assistants will administer the 15-item Health Utility Index,Patient Health Questionnaire,Generalized Anxiety Disorder Scale,and Medical Outcomes Study at baseline,1,6,and 12 months. Information about advanced care planning will be collected at baseline and 12 months. All enrollees' medical records will be reviewed to collect data on health care utilization and costs. We have two primary hypotheses; first,in comparison to non-screened subjects,those who are screened and referred to a dementia collaborative care program will have a higher health-related quality of life as measured by the Health Utility Index at 12 months post-screening. Second,in comparison to non-screened subjects,those who are screened and referred to a dementia collaborative care program will not have higher depression or anxiety at one month post-screening as measured by the Patient Health Questionnaire and Generalized Anxiety Disorder Scale scales. Our secondary hypothesis is that screened subjects will have an Incremental Cost-Effectiveness Ratio below the maximum acceptable threshold of $60,000 per quality adjusted life year saved at 12 months. Ongoing; registered on September 19,2012. ClinicalTrials.gov Identifier: 2012 NCT01699503."," Trials. 2014 Jun 6;15():209. ","USA",2014,"Any dementia","Diagnosis",null,null,null,"Cost-utility",null,"USA",null,"Any dementia","Diagnosis","Cost-utility",null,null,"2010:2014"]
[11,"Quinn C,Anderson D,Toms G,Whitaker R,Edwards RT,Jones C,Clare L. Self-management in early-stage dementia: a pilot randomised controlled trial of the efficacy and cost-effectiveness of a self-management group intervention (the SMART study). Trials. 2014 Mar 8;15():74. ","doi: 10.1186/1745-6215-15-74. ","Quinn C,Anderson D,Toms G,Whitaker R,Edwards RT,Jones C,Clare L."," Self-management in early-stage dementia: a pilot randomised controlled trial of the efficacy and cost-effectiveness of a self-management group intervention (the SMART study).","The possibility of living well with a long-term condition has been identified as centrally relevant to the needs of people living with dementia. Growing numbers of people with early-stage dementia are contributing accounts that emphasise the benefits of actively engaging in managing the condition. Self-management interventions share the common objectives of educating about the condition,optimising well-being,enhancing control over the situation and enabling people to take more responsibility for managing the condition. Benefits of such an approach can include improved knowledge,self-efficacy,health status,and better performance of self-management behaviours. However,there is only preliminary evidence that people with early-stage dementia can benefit from such interventions. This feasibility study involves the development of a self-management group intervention for people with early-stage Alzheimer's disease,vascular dementia or mixed Alzheimer's and vascular dementia. This study is a single-site pilot randomised-controlled trial. Forty-two people with early stage dementia,each with a caregiver (family member/friend),will be randomised to either the self-management group intervention or to treatment as usual.The self-management group intervention will involve eight weekly sessions,each lasting 90 minutes,held at a memory clinic in North Wales. All participants will be re-assessed three and six months post-randomisation. This study is intended to supply an early evaluation of the self-management intervention so that a full scale trial may be powered from the best available evidence. It will assess the feasibility of the intervention,the study design and the recruitment strategies. It will estimate the parameters and confidence intervals for the research questions of interest. The primary outcome of interest is the self-efficacy score of the person with dementia at three months post-randomisation. Secondary outcomes for the person with dementia are self-efficacy at six months post-randomisation and cognitive ability,mood and well-being at three and six months post-randomisation. Secondary outcomes for caregivers are their distress and stress at three and six months post-randomisation. The cost-effectiveness of the intervention will also be examined. This study will provide preliminary information about the feasibility,efficacy and cost-effectiveness of a self-management group intervention for people in the early stages of dementia. Current Controlled Trials,ISRCTN02023181."," Trials. 2014 Mar 8;15():74. ","UK",2014,"Alzheimer’s,Vascular dementia","Behavioural therapies",null,null,null,"Unclear",null,"UK",null,"Alzheimer’s,Vascular dementia","Behavioural therapies","Unclear",null,null,"2010:2014"]
[12,"Bermingham SL. The appropriate use of neuroimaging in the diagnostic work-up of dementia: an economic literature review and cost-effectiveness analysis. Ont Health Technol Assess Ser. 2014;14(2):1-67. ",null,"Bermingham SL."," The appropriate use of neuroimaging in the diagnostic work-up of dementia: an economic literature review and cost-effectiveness analysis.","Structural brain imaging is often performed to establish the underlying causes of dementia. However,recommendations differ as to who should receive neuroimaging and whether computed tomography (CT) or magnetic resonance imaging (MRI) should be used. This study aimed to determine the cost-effectiveness in Ontario of offering structural imaging to all patients with mild to moderate dementia compared with offering it selectively according to guidelines from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCC). We compared the cost-effectiveness of CT and MRI as first-line strategies. We performed a systematic literature search (2000 to 2013) to identify cost-effectiveness studies of clinical prediction rules and structural imaging modalities. Studies were assessed for quality and applicability to Ontario. We also developed a model to evaluate the cost-effectiveness of clinical guidelines (image all versus according to CCC) and modalities (CT versus MRI). Transition probabilities,utilities,and costs were obtained from published literature or expert opinion. Results were expressed in terms of costs and quality adjusted life years (QALYs). No relevant cost-effectiveness analyses were identified in the published literature. According to the base-case results of our model,the most effective and cost-effective strategy is to image patients who meet CCC criteria with CT and to follow-up with MRI for suspected cases of space-occupying lesions (SOL). However,the results were sensitive to the specificity of MRI for detecting vascular causes of dementia. At a specificity of 64%,the most cost-effective strategy is CCC followed by MRI. Studies used to estimate diagnostic accuracy were limited by a lack of a gold standard test for establishing the cause of dementia. The model does not include costs to patients and their families,nor does it account for patient preferences about diagnostic information. Given the relative prevalence of vascular dementia and SOLs,and the improvement in QALYs associated with treatment,the strategy with the greatest combined sensitivity (CCC with CT followed by MRI for patients with SOLs) results in the greatest number of QALYs and is the least costly. Due to limitations in the clinical data and challenges in the interpretation of this evidence,the model should be considered a framework for assessing uncertainty in the evidence base rather than providing definitive answers to the research questions."," Ont Health Technol Assess Ser. 2014;14(2):1-67. ","International",2014,"Any dementia","Diagnosis",null,null,null,"Cost-utility",null,"International",null,"Any dementia","Diagnosis","Cost-utility",null,null,"2010:2014"]
[13,"Sonntag M,König HH,Konnopka A. The estimation of utility weights in cost-utility analysis for mental disorders: a systematic review. Pharmacoeconomics. 2013 Dec;31(12):1131-54. ","doi: 10.1007/s40273-013-0107-9.","Sonntag M,König HH,Konnopka A."," The estimation of utility weights in cost-utility analysis for mental disorders: a systematic review.","To systematically review approaches and instruments used to derive utility weights in cost-utility analyses (CUAs) within the field of mental disorders and to identify factors that may have influenced the choice of the approach. We searched the databases DARE (Database of Abstracts of Reviews of Effects),NHS EED (National Health Service Economic Evaluation Database),HTA (Health Technology Assessment),and PubMed for CUAs. Studies were included if they were full economic evaluations and reported quality-adjusted life-years as the health outcome. Study characteristics and instruments used to estimate utility weights were described and a logistic regression analysis was conducted to identify factors associated with the choice of either the direct (e.g. standard gamble) or the preference-based measure (PBM) approach (e.g. EQ-5D). We identified 227 CUAs with a maximum in 2009,2010,and 2012. Most CUAs were conducted in depression,dementia,or psychosis,and came from the US or the UK,with the EQ-5D being the most frequently used instrument. The application of the direct approach was significantly associated with depression,psychosis,and model-based studies. The PBM approach was more likely to be used in recent studies,dementia,Europe,and empirical studies. Utility weights used in model-based studies were derived from only a small number of studies. We only searched four databases and did not evaluate the quality of the included studies. Direct instruments and PBMs are used to elicit utility weights in CUAs with different frequencies regarding study type,mental disorder,and country."," Pharmacoeconomics. 2013 Dec;31(12):1131-54. ","International",2013,"Any dementia","None or unclear",null,null,null,"Cost-utility",null,"International",null,"Any dementia","None or unclear","Cost-utility",null,null,"2010:2014"]
[14,"Meeuwsen E,Melis R,van der Aa G,Golüke-Willemse G,de Leest B,van Raak F,Schölzel-Dorenbos C,Verheijen D,Verhey F,Visser M,Wolfs C,Adang E,Olde Rikkert M. Cost-effectiveness of one year dementia follow-up care by memory clinics or general practitioners: economic evaluation of a randomised controlled trial. PLoS One. 2013;8(11):e79797. ","doi: 10.1371/journal.pone.0079797.","Meeuwsen E,Melis R,van der Aa G,Golüke-Willemse G,de Leest B,van Raak F,Schölzel-Dorenbos C,Verheijen D,Verhey F,Visser M,Wolfs C,Adang E,Olde Rikkert M."," Cost-effectiveness of one year dementia follow-up care by memory clinics or general practitioners: economic evaluation of a randomised controlled trial.","To evaluate the cost-effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared to general practitioners' care. A multicentre randomised trial with 175 community dwelling patients newly diagnosed with mild to moderate dementia,and their informal caregivers,with twelve months' follow-up. Cost-effectiveness was evaluated from a societal point of view and presented as incremental cost per quality adjusted life year. To establish cost-effectiveness,a cost-utility analysis was conducted using utilities based on the EQ-5D. Uncertainty surrounding the incremental cost-effectiveness ratio (difference in costs divided by difference in effects) was calculated by bootstrapping from the original data. Compared to general practitioners' care,treatment by the memory clinics was on average €1024 (95% CI: -€7723 to €5674) cheaper,and showed a non-significant decrease of 0.025 (95% CI: -0.114 to 0.064) quality adjusted life years. The incremental cost-effectiveness point estimate from the bootstrap simulation was € 41 442 per QALY lost if one would use memory clinic care instead of general practitioner care. No evidence was found that memory clinics were more cost-effective compared to general practitioners with regard to post-diagnosis treatment and coordination of care of patients with dementia in the first year after diagnosis. ClinicalTrials.gov NCT00554047."," PLoS One. 2013;8(11):e79797. ","Netherlands",2013,"Any dementia","Memory clinic",null,null,null,"Cost-effectiveness,Cost-utility",null,"Netherlands",null,"Any dementia","Memory clinic","Cost-effectiveness,Cost-utility",null,null,"2010:2014"]
[15,"Saulle R,Semyonov L,La Torre G. Cost and cost-effectiveness of the Mediterranean diet: results of a systematic review. Nutrients. 2013 Nov 18;5(11):4566-86. ","doi: 10.3390/nu5114566.","Saulle R,Semyonov L,La Torre G."," Cost and cost-effectiveness of the Mediterranean diet: results of a systematic review.","The growing impact of chronic degenerative pathologies (such as cardiovascular disease,type 2 diabetes and Alzheimer's disease) requires and pushes towards the development of new preventive strategies to reduce the incidence and prevalence of these diseases. Lifestyle changes,especially related to the Mediterranean diet,have the potential to modify disease outcomes and ultimately costs related to their management. The objective of the study was to perform a systematic review of the scientific literature,to gauge the economic performance and the cost-effectiveness of the adherence to the Mediterranean diet as a prevention strategy against degenerative pathologies. We investigated the monetary costs of adopting Mediterranean dietary patterns by determining cost differences between low and high adherence. Research was conducted using the PubMed and Scopus databases. Eight articles met the pre-determined inclusion criteria and were reviewed. Quality assessment and data extraction was performed. The adherence to the Mediterranean diet has been extensively reported to be associated with a favorable health outcome and a better quality of life. The implementation of a Mediterranean dietary pattern may lead to the prevention of degenerative pathologies and to an improvement in life expectancy,a net gain in health and a reduction in total lifetime costs."," Nutrients. 2013 Nov 18;5(11):4566-86. ","International",2013,"Any dementia","Diet",null,null,null,"Unclear",null,"International",null,"Any dementia","Diet","Unclear",null,null,"2010:2014"]
[16,"Knapp M,King D,Romeo R,Schehl B,Barber J,Griffin M,Rapaport P,Livingston D,Mummery C,Walker Z,Hoe J,Sampson EL,Cooper C,Livingston G. Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial. BMJ. 2013 Oct 25;347():f6342.",null,"Knapp M,King D,Romeo R,Schehl B,Barber J,Griffin M,Rapaport P,Livingston D,Mummery C,Walker Z,Hoe J,Sampson EL,Cooper C,Livingston G."," Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial.","To assess whether the START (STrAtegies for RelatTives) intervention added to treatment as usual is cost effective compared with usual treatment alone. Cost effectiveness analysis nested within a pragmatic randomised controlled trial. Three mental health and one neurological outpatient dementia service in London and Essex,UK. Family carers of people with dementia. Eight session,manual based,coping intervention delivered by supervised psychology graduates to family carers of people with dementia added to usual treatment,compared with usual treatment alone. Costs measured from a health and social care perspective were analysed alongside the Hospital Anxiety and Depression Scale total score (HADS-T) of affective symptoms and quality adjusted life years (QALYs) in cost effectiveness analyses over eight months from baseline. Of the 260 participants recruited to the study,173 were randomised to the START intervention,and 87 to usual treatment alone. Mean HADS-T scores were lower in the intervention group than the usual treatment group over the 8 month evaluation period (mean difference -1.79 (95% CI -3.32 to -0.33)),indicating better outcomes associated with the START intervention. There was a small improvement in health related quality of life as measured by QALYs (0.03 (-0.01 to 0.08)). Costs were no different between the intervention and usual treatment groups (£252 (-28 to 565) higher for START group). The cost effectiveness calculations suggested that START had a greater than 99% chance of being cost effective compared with usual treatment alone at a willingness to pay threshold of £30,000 per QALY gained,and a high probability of cost effectiveness on the HADS-T measure. The manual based coping intervention START,when added to treatment as usual,was cost effective compared with treatment as usual alone by reference to both outcome measures (affective symptoms for family carers,and carer based QALYs). ISCTRN 70017938."," BMJ. 2013 Oct 25;347():f6342.","UK",2013,"Any dementia","Support",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Support","Cost-utility",null,null,"2010:2014"]
[17,"Dahlrup B,Nordell E,Steen Carlsson K,Elmståhl S. Health economic analysis on a psychosocial intervention for family caregivers of persons with dementia. Dement Geriatr Cogn Disord. 2014;37(3-4):181-95. ","doi: 10.1159/000355365.","Dahlrup B,Nordell E,Steen Carlsson K,Elmståhl S."," Health economic analysis on a psychosocial intervention for family caregivers of persons with dementia.","Psychosocial intervention has shown positive effects on the caregivers' burden and satisfaction. The aims of this study were to describe the cost and cost-effectiveness of such an intervention. We analyzed resource use and costs of formal care for 308 persons with dementia and their caregivers' health-related quality of life (HRQoL). The costs of home help services were lower in the subgroup of spouse caregivers in the intervention group and the cost of nursing home placement was lower in the intervention group. While the person with dementia lived at home,caregivers in the intervention group reported a higher HRQoL (p < 0.01). After the person with dementia had moved to a nursing home,spouses in the control group had a lower HRQoL (p < 0.001). The result can be interpreted as a positive effect of the intervention focusing on the identified specific needs of the family caregivers."," Dement Geriatr Cogn Disord. 2014;37(3-4):181-95. ","Sweden",2014,"Any dementia","Other psychological therapies",null,null,null,"Cost-utility",null,"Sweden",null,"Any dementia","Other psychological therapies","Cost-utility",null,null,"2010:2014"]
[18,"Goldfeld KS. Twice-weighted multiple interval estimation of a marginal structural model to analyze cost-effectiveness. Stat Med. 2014 Mar 30;33(7):1222-41. ","doi: 10.1002/sim.6017. ","Goldfeld KS."," Twice-weighted multiple interval estimation of a marginal structural model to analyze cost-effectiveness.","Cost-effectiveness analysis is an important tool that can be applied to the evaluation of a health treatment or policy. When the observed costs and outcomes result from a nonrandomized treatment,making causal inference about the effects of the treatment requires special care. The challenges are compounded when the observation period is truncated for some of the study subjects. This paper presents a method of unbiased estimation of cost-effectiveness using observational study data that is not fully observed. The method-twice-weighted multiple interval estimation of a marginal structural model-was developed in order to analyze the cost-effectiveness of treatment protocols for advanced dementia residents living nursing homes when they become acutely ill. A key feature of this estimation approach is that it facilitates a sensitivity analysis that identifies the potential effects of unmeasured confounding on the conclusions concerning cost-effectiveness."," Stat Med. 2014 Mar 30;33(7):1222-41. ","Unknown",2014,"Any dementia","Disease management",null,null,null,"Unclear",null,"Unknown",null,"Any dementia","Disease management","Unclear",null,null,"2010:2014"]
[19,"Joling KJ,Bosmans JE,van Marwijk HW,van der Horst HE,Scheltens P,Vroomen JL,van Hout HP. The cost-effectiveness of a family meetings intervention to prevent depression and anxiety in family caregivers of patients with dementia: a randomized trial. Trials. 2013 Sep 22;14():305. ","doi: 10.1186/1745-6215-14-305.","Joling KJ,Bosmans JE,van Marwijk HW,van der Horst HE,Scheltens P,Vroomen JL,van Hout HP."," The cost-effectiveness of a family meetings intervention to prevent depression and anxiety in family caregivers of patients with dementia: a randomized trial.","Dementia imposes a heavy burden on health and social care systems as well as on family caregivers who provide a substantial portion of the care. Interventions that effectively support caregivers may prevent or delay patient institutionalization and hence be cost-effective. However,evidence about the cost-effectiveness of such interventions is scarce. The aim of this study was to evaluate the cost-effectiveness of a family meetings intervention for family caregivers of dementia patients in comparison with usual care over a period of 12 months. The economic evaluation was conducted from a societal perspective alongside a randomized trial of 192 primary caregivers with community-dwelling dementia patients. Outcome measures included the Quality Adjusted Life-Years (QALY) of caregivers and patients and the incidence of depression and anxiety disorders in caregivers. Missing cost and effect data were imputed using multiple imputations. Bootstrapping was used to estimate uncertainty around the cost-differences and the incremental cost-effectiveness ratio (ICER). The bootstrapped cost-effect pairs were plotted on a cost-effectiveness plane and used to estimate cost-effectiveness curves. No significant differences in costs and effects between the groups were found. At 12 months,total costs per patient and primary caregiver dyad were substantial: €77,832 for the intervention group and €75,201 for the usual care group (adjusted mean difference per dyad €4,149,95% CI -13,371 to 21,956,ICER 157,534). The main cost driver was informal care (66% of total costs),followed by patients' day treatment and costs of hospital and long-term care facility admissions (23%). Based on the cost-effectiveness acceptability curves,the maximum probability that the intervention was considered cost-effective in comparison with usual care reached 0.4 for the outcome QALY per patient-caregiver dyad and 0.6 for the caregivers' incidence of depression and/or anxiety disorders regardless of the willingness to pay. The annual costs of caring for a person with dementia were substantial with informal care being by far the largest contributor to the total societal costs. Based on this study,family meetings cannot be considered a cost-effective intervention strategy in comparison with usual care. ISRCTN register,ISRCTN90163486."," Trials. 2013 Sep 22;14():305. ","Netherlands",2013,"Any dementia","Caregiver support",null,null,null,"Cost-utility",null,"Netherlands",null,"Any dementia","Caregiver support","Cost-utility",null,null,"2010:2014"]
[20,"Leach MJ,Francis A,Ziaian T. Improving the health and well-being of community-dwelling caregivers of dementia sufferers: study protocol of a randomized controlled trial of structured meditation training. J Altern Complement Med. 2014 Feb;20(2):136-41. ","doi: 10.1089/acm.2013.0170. ","Leach MJ,Francis A,Ziaian T."," Improving the health and well-being of community-dwelling caregivers of dementia sufferers: study protocol of a randomized controlled trial of structured meditation training.","Caring for a person with dementia can be an unrelenting and burdensome task,one that is often detrimental to the caregiver's health,well-being,and functionality. The enduring stress and frustration of the caregiver role can also contribute to poorer outcomes for dementia sufferers. Building on growing clinical interest in the capacity for Transcendental Meditation(®) (TM; a relaxation technique) to reduce stress and anxiety in healthy workers,this study examines whether similar improvements could be experienced by dementia caregivers. The study objective was to ascertain whether a TM program can improve psychological stress,quality of life,affect,and cognitive performance of dementia caregivers. The study was a pilot prospective,single-center,randomized wait-list controlled trial with two parallel arms. Community-dwelling carers of persons with diagnosed dementia,residing in metropolitan Adelaide,South Australia,were included in this study. Participants will be randomly assigned to a 13-hour TM training program or wait-list control over 12 weeks. Primary outcomes include quality of life and stress. Secondary outcomes include affect,cognitive performance,cost-effectiveness,and study feasibility. Outcomes will be assessed at baseline,week 12 (postintervention),and week 24 (follow-up). Results are expected to be available early in 2014. This project responds to a need for robust evidence of the clinical and economic effectiveness of TM for the management of caregiver stress. If Transcendental Meditation is shown to be effective,it could indicate a simple,cost-effective,and easily implemented strategy to assist many of the growing numbers of caregivers to cope with the demanding and often difficult caregiver role."," J Altern Complement Med. 2014 Feb;20(2):136-41. ","Australia",2014,"Any dementia","Support",null,null,null,"Cost-utility",null,"Australia",null,"Any dementia","Support","Cost-utility",null,null,"2010:2014"]
[21,"Touchon J,Lachaine J,Beauchemin C,Granghaud A,Rive B,Bineau S. The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer's disease to nursing homes: cost-effectiveness analysis in France. Eur J Health Econ. 2014 Nov;15(8):791-800. ","doi: 10.1007/s10198-013-0523-y. ","Touchon J,Lachaine J,Beauchemin C,Granghaud A,Rive B,Bineau S."," The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer's disease to nursing homes: cost-effectiveness analysis in France.","The costs associated with the care of Alzheimer's disease patients are very high,particularly those associated with nursing home placement. The combination of a cholinesterase inhibitor (ChEI) and memantine has been shown to significantly delay admission to nursing homes as compared to treatment with a ChEI alone. The objective of this cost-effectiveness analysis was to evaluate the economic impact of the concomitant use of memantine and ChEI compared to ChEI alone. Markov modelling was used in order to simulate transitions over time among three discrete health states (non-institutionalised,institutionalised and deceased). Transition probabilities were obtained from observational studies and French national statistics,utilities from a previous US survey and costs from French national statistics. The analysis was conducted from societal and healthcare system perspectives. Mean time to nursing home admission was 4.57 years for ChEIs alone and 5.54 years for combination therapy,corresponding to 0.98 additional years,corresponding to a gain in quality adjusted life years (QALYs) of 0.25. From a healthcare system perspective,overall costs were €98,609 for ChEIs alone and €90,268 for combination therapy,representing cost savings of €8,341. From a societal perspective,overall costs were €122,039 and €118,721,respectively,representing cost savings of €3,318. Deterministic and probabilistic (Monte Carlo simulations) sensitivity analyses indicated that combination therapy would be the dominant strategy in most scenarios. In conclusion,combination therapy with memantine and a ChEI is a cost-saving alternative compared to ChEI alone as it is associated with lower cost and increased QALYs from both a societal and a healthcare perspective."," Eur J Health Econ. 2014 Nov;15(8):791-800. ","France",2014,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility",null,"France",null,"Alzheimer’s","Any anticholinesterase,Memantine","Cost-utility",null,null,"2010:2014"]
[22,"Clare L,Bayer A,Burns A,Corbett A,Jones R,Knapp M,Kopelman M,Kudlicka A,Leroi I,Oyebode J,Pool J,Woods B,Whitaker R. Goal-oriented cognitive rehabilitation in early-stage dementia: study protocol for a multi-centre single-blind randomised controlled trial (GREAT). Trials. 2013 May 27;14():152. ","doi: 10.1186/1745-6215-14-152. ","Clare L,Bayer A,Burns A,Corbett A,Jones R,Knapp M,Kopelman M,Kudlicka A,Leroi I,Oyebode J,Pool J,Woods B,Whitaker R."," Goal-oriented cognitive rehabilitation in early-stage dementia: study protocol for a multi-centre single-blind randomised controlled trial (GREAT).","Preliminary evidence suggests that goal-oriented cognitive rehabilitation (CR) may be a clinically effective intervention for people with early-stage Alzheimer's disease,vascular or mixed dementia and their carers. This study aims to establish whether CR is a clinically effective and cost-effective intervention for people with early-stage dementia and their carers. In this multi-centre,single-blind randomised controlled trial,480 people with early-stage dementia,each with a carer,will be randomised to receive either treatment as usual or cognitive rehabilitation (10 therapy sessions over 3 months,followed by 4 maintenance sessions over 6 months). We will compare the effectiveness of cognitive rehabilitation with that of treatment as usual with regard to improving self-reported and carer-rated goal performance in areas identified as causing concern by people with early-stage dementia; improving quality of life,self-efficacy,mood and cognition of people with early-stage dementia; and reducing stress levels and ameliorating quality of life for carers of participants with early-stage dementia. The incremental cost-effectiveness of goal-oriented cognitive rehabilitation compared to treatment as usual will also be examined. If the study confirms the benefits and cost-effectiveness of cognitive rehabilitation,it will be important to examine how the goal-oriented cognitive rehabilitation approach can most effectively be integrated into routine health-care provision. Our aim is to provide training and develop materials to support the implementation of this approach following trial completion."," Trials. 2013 May 27;14():152. ","UK",2013,"Alzheimer’s,Vascular dementia","Cognitive therapies",null,null,null,"Cost-utility",null,"UK",null,"Alzheimer’s,Vascular dementia","Cognitive therapies","Cost-utility",null,null,"2010:2014"]
[23,"Banerjee S,Hellier J,Romeo R,Dewey M,Knapp M,Ballard C,Baldwin R,Bentham P,Fox C,Holmes C,Katona C,Lawton C,Lindesay J,Livingston G,McCrae N,Moniz-Cook E,Murray J,Nurock S,Orrell M,O'Brien J,Poppe M,Thomas A,Walwyn R,Wilson K,Burns A. Study of the use of antidepressants for depression in dementia: the HTA-SADD trial--a multicentre,randomised,double-blind,placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine. Health Technol Assess. 2013 Feb;17(7):1-166. ","doi: 10.3310/hta17070.","Banerjee S,Hellier J,Romeo R,Dewey M,Knapp M,Ballard C,Baldwin R,Bentham P,Fox C,Holmes C,Katona C,Lawton C,Lindesay J,Livingston G,McCrae N,Moniz-Cook E,Murray J,Nurock S,Orrell M,O'Brien J,Poppe M,Thomas A,Walwyn R,Wilson K,Burns A."," Study of the use of antidepressants for depression in dementia: the HTA-SADD trial--a multicentre,randomised,double-blind,placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine.","Depression is common in dementia,causing considerable distress and other negative impacts. Treating it is a clinical priority,but the evidence base is sparse and equivocal. This trial aimed to determine clinical effectiveness of sertraline and mirtazapine in reducing depression 13 weeks post randomisation compared with placebo. Multicentre,parallel-group,double-blind placebo-controlled randomised controlled trial of the clinical effectiveness of sertraline and mirtazapine with 13- and 39-week follow-up. Nine English old-age psychiatry services. A pragmatic trial. Eligibility: probable or possible Alzheimer's disease (AD),depression (4+ weeks) and Cornell Scale for Depression in Dementia (CSDD) score of 8+. clinically too critical (e.g. suicide risk); contraindication to medication; taking antidepressants; in another trial; and having no carer. (1) Sertraline; (2) mirtazapine; and (3) placebo,all with normal care. Target doses: 150 mg of sertraline or 45 mg of mirtazapine daily. CSDD score. Randomisation: Allocated 1 : 1 : 1 through Trials Unit,independently of trial team. Stratified block randomisation by centre,with randomly varying block sizes; computer-generated randomisation. Blinding: Double blind: medication and placebo identical for each antidepressant. Referring clinicians,research workers,participants and pharmacies were blind. Statisticians blind until analyses completed. Numbers randomised: 326 participants randomised (111 placebo,107 sertraline and 108 mirtazapine). Differences in CSDD at 13 weeks from an adjusted linear-mixed model: mean difference (95% CI) placebo-sertraline 1.17 (-0.23 to 2.78; p = 0.102); placebo-mirtazapine 0.01 (-1.37 to 1.38; p = 0.991); and mirtazapine-sertraline 1.16 (-0.27 to 2.60; p = 0.112). Placebo group had fewer adverse reactions (29/111,26%) than sertraline (46/107,43%) or mirtazapine (44/108,41%; p = 0.017); 39-week mortality equal,five deaths in each group. This is a trial with negative findings but important clinical implications. The data suggest that the antidepressants tested,given with normal care,are not clinically effective (compared with placebo) for clinically significant depression in AD. This implies a need to change current practice of antidepressants being the first-line treatment of depression in AD. From the data generated we formulated the following recommendations for future work. (1) The secondary analyses presented here suggest that there would be value in carrying out a placebo-controlled trial of the clinical effectiveness and cost-effectiveness of mirtazapine in the management of Behavioural and Psychological Symptoms of Dementia. (2) A conclusion from this study is that it remains both ethical and essential for trials of new medication for depression in dementia to have a placebo arm. (3) Further research is required to evaluate the impact that treatments for depression in people with dementia can have on their carers not only in terms of any impacts on their quality of life,but also the time they spend care-giving. (4) There is a need for research into alternative biological and psychological therapies for depression in dementia. These could include evaluations of new classes of antidepressants (such as venlafaxine) or antidementia medication (e.g. cholinesterase inhibitors). (5) Research is needed to investigate the natural history of depression in dementia in the community when patients are not referred to secondary care services. (6) Further work is needed to investigate the cost modelling results in this rich data set,investigating carer burden and possible moderators to the treatment effects. (7) There is scope for reanalysis of the primary outcome in terms of carer and participant CSDD results."," Health Technol Assess. 2013 Feb;17(7):1-166. ","UK",2013,"Alzheimer’s","Antidepressants",null,null,null,"Unclear",null,"UK",null,"Alzheimer’s","Antidepressants","Unclear",null,null,"2010:2014"]
[24,"Woods RT,Bruce E,Edwards RT,Elvish R,Hoare Z,Hounsome B,Keady J,Moniz-Cook ED,Orgeta V,Orrell M,Rees J,Russell IT. REMCARE: reminiscence groups for people with dementia and their family caregivers - effectiveness and cost-effectiveness pragmatic multicentre randomised trial. Health Technol Assess. 2012;16(48):v-xv,1-116. ","doi: 10.3310/hta16480. ","Woods RT,Bruce E,Edwards RT,Elvish R,Hoare Z,Hounsome B,Keady J,Moniz-Cook ED,Orgeta V,Orrell M,Rees J,Russell IT."," REMCARE: reminiscence groups for people with dementia and their family caregivers - effectiveness and cost-effectiveness pragmatic multicentre randomised trial.","The aim of the REMiniscence groups for people with dementia and their family CAREgivers (REMCARE) study was to assess the effectiveness and cost-effectiveness of joint reminiscence groups for people with dementia and their family caregivers as compared with usual care. A multicentre,pragmatic randomised controlled trial with two parallel arms - an intervention group and a usual-care control group - was carried out. A restricted dynamic method of randomisation was used with an overall allocation ratio of 1 : 1,restricted to ensure intervention groups of a viable size. Assessments,blind to treatment allocation,were carried out at baseline,3 months and 10 months (primary end point). Most participants were recruited through NHS Memory Clinics and Community Mental Health Teams for older people. Assessments were usually carried out in the person's home,and treatment groups were held in a variety of community settings. A total of 488 individuals (mean age 77.5 years) with mild to moderate dementia (meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria),who were initially living in the community,and who had a relative or other caregiver maintaining regular contact,who could act as an informant and was willing and able to participate in the intervention,were recruited to the study. Most carers were spouses (71%). A total of 350 dyads completed the study. The intervention consisted of joint reminiscence groups held weekly for 12 consecutive weeks,followed by monthly maintenance sessions for a further 7 months. The sessions followed a treatment manual,and were led by two trained facilitators in each centre,supported by a number of volunteers. Up to 12 dyads were invited to attend each group. The primary outcome measures were self-reported quality of life for the person with dementia and psychological distress for the carer [General Health Questionnaire-28 item version (GHQ-28)]. Secondary outcome measures included autobiographical memory and activities of daily living for the person with dementia,carer stress for the carer and mood,relationship quality and service use and costs for both parties. The intention-to-treat analysis identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes [self-reported quality of life in Alzheimer's disease: mean difference 0.07,standard error (SE) 0.65; F = 0.48; p = 0.53]. Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a subscale of the GHQ-28 at the 10-month end point (mean difference 1.25,SE 0.5; F = 8.28; p = 0.04). Compliance analyses suggested some benefits for people with dementia who attended more reminiscence sessions; however,carers attending more groups showed increased caregiving stress. Use of health- and social-care services was modest,with no significant difference in service use between conditions. Owing to negligible difference in quality-adjusted life-year gains (derived from European Quality of Life-5 Dimensions) between the conditions the planned full economic analysis was curtailed. This trial does not provide support for the effectiveness or cost-effectiveness of joint reminiscence groups for people with dementia and their carers. Although there may be some beneficial effects for people with dementia who attend sessions as planned,this must be viewed in the context of raised anxiety and stress in their carers. The reasons for these discrepant outcomes need to be explored further,and may necessitate reappraisal of the movement towards joint interventions. Current Controlled Trials ISRCTN42430123. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 16,No. 48. See the HTA programme website for further project information."," Health Technol Assess. 2012;16(48):v-xv,1-116. ","UK",2012,"Any dementia","Other psychological therapies",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Other psychological therapies","Cost-utility",null,null,"2010:2014"]
[25,"Laakkonen ML,Hölttä EH,Savikko N,Strandberg TE,Suominen M,Pitkälä KH. Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial. Trials. 2012 Aug 7;13():133. ","doi: 10.1186/1745-6215-13-133.","Laakkonen ML,Hölttä EH,Savikko N,Strandberg TE,Suominen M,Pitkälä KH."," Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial.","After diagnosis of a dementing illness,patients and their spouses have many concerns related to the disease and their future. This often leads to poor psychological well-being and reduced health-related quality of life (HRQoL) of the family. Support for self-management skills has been proven to be an effective method to improve prognosis of asthma,heart failure and osteoarthritis. However,self-management interventions have not been studied in dementia. Therefore,our aim was to examine,in an objective-oriented group intervention,the efficacy of self-management support program (SMP) on the HRQoL of dementia patients and their spousal caregivers as well as on the sense of competence and psychological well-being of caregivers. During the years 2011 to 12,160 dementia patients and their spouses will be recruited from memory clinics and randomized into two arms: 80 patients for group-based SMP sessions including topics selected by the participants,80 patients will serve as controls in usual community care. Sessions may include topics on dementia,community services,active lifestyle and prevention for cognitive decline,spousal relationship,future planning and emotional well-being. The patients and spouses will have their separate group sessions (ten participants per group) once a week for eight weeks. Main outcome measures will be patients' HRQoL (15D) and spousal caregivers' HRQoL (RAND-36),and sense of competence (SCQ). Secondary measures will be caregivers' psychological well-being (GHQ-12) and coping resources,patients' depression,cognition and signs of frailty. Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two-year follow-up. This is a 'proof-of-concept' study to explore the efficacy of group support for self-management skills among dementia families. It will also provide data on cost-effectiveness of the intervention. ACTRN12611001173987."," Trials. 2012 Aug 7;13():133. ","Finland",2012,"Any dementia","Other psychological therapies",null,null,null,"Cost-utility",null,"Finland",null,"Any dementia","Other psychological therapies","Cost-utility",null,null,"2010:2014"]
[26,"Teljeur C,Flattery M,Harrington P,O'Neill M,Moran PS,Murphy L,Ryan M. Cost-effectiveness of prion filtration of red blood cells to reduce the risk of transfusion-transmitted variant Creutzfeldt-Jakob disease in the Republic of Ireland. Transfusion. 2012 Nov;52(11):2285-93. ","doi: 10.1111/j.1537-2995.2012.03637.x. ","Teljeur C,Flattery M,Harrington P,O'Neill M,Moran PS,Murphy L,Ryan M."," Cost-effectiveness of prion filtration of red blood cells to reduce the risk of transfusion-transmitted variant Creutzfeldt-Jakob disease in the Republic of Ireland.","Variant Creutzfeldt-Jakob disease (vCJD) is a rare,progressive fatal noninflammatory neurodegenerative disease. Ireland has the second highest rate of vCJD in the world with an ongoing risk of vCJD transmission through blood transfusion. Prion-removing filters have been developed to reduce the risk of vCJD transmission. This study aimed to evaluate the cost-effectiveness of implementing a policy of prion filtration of red blood cells (RBCs) in the Republic of Ireland. A cost-effectiveness model was developed to simulate the likelihood of RBC recipients developing clinical vCJD as a result of being transfused with infected RBCs. Model variables were collected from published literature and expert opinion. Costs were estimated based on the processing changes required to implement prion filtration. In the absence of prion filtration,it is estimated that two individuals will develop clinical vCJD arising from RBC transfusions over a 10-year time horizon. The discounted life-years lost will be 18.5 years. With prion filtration,there will be no deaths or life-years lost. The discounted cost of universal prion filtration is €68.2 million over 10 years with a corresponding incremental cost-effectiveness ratio of €3.7 million per life-year gained. In 25.3% of simulations there were no deaths from vCJD infection through infected blood transfusions,irrespective of prion filtration. Prion filtration is considered not cost-effective by traditional measures. Although numerous non-cost-effective blood safety strategies have been implemented in the past,consideration should be given to the most efficient use of finite resources in transfusion medicine."," Transfusion. 2012 Nov;52(11):2285-93. ","Ireland",2012,"CJD","Prevention",null,null,null,"Cost-effectiveness",null,"Ireland",null,"CJD","Prevention","Cost-effectiveness",null,null,"2010:2014"]
[27,"Shearer J,Green C,Ritchie CW,Zajicek JP. Health state values for use in the economic evaluation of treatments for Alzheimer's disease. Drugs Aging. 2012 Jan 1;29(1):31-43. ","doi: 10.2165/11597380-000000000-00000. ","Shearer J,Green C,Ritchie CW,Zajicek JP."," Health state values for use in the economic evaluation of treatments for Alzheimer's disease.","Alzheimer's disease (AD) is a chronic,progressive,neurodegenerative disease that places a heavy burden on people with the condition,their families and carers,health care systems and society in general. Health-related quality of life (HR-QOL) in patients deteriorates as the cognitive,behavioural and functional symptoms of AD develop. The human and financial cost of AD is forecast to grow rapidly as populations age,and those responsible for planning and financing health care face the challenge of allocating increasingly scarce resources against current and future interventions targeted towards AD. These include calls for early detection and diagnosis,preventative strategies,new medications,residential care,supportive care,and meeting the needs of carers as well as patients. Health care funders in many health systems now require a demonstration of the value of new interventions through a comparison of benefits in terms of improvements in HR-QOL and costs relative to those of competing or existing practices. Changes in HR-QOL provide the basis for the calculation of the quality-adjusted life-year (QALY),a key outcome used in economic evaluations to compare treatments within and between different disease conditions. The objective of this systematic review was to provide a summary of the published health state values (utilities) for AD patients and their carers that are currently available to estimate QALYs for use in health economic evaluations of interventions in AD. The health care literature was searched for articles published in English between 2000 and 2011,using keywords and variants including 'quality-adjusted life years','health state indicators','health utilities' and the specific names of generic measures of HR-QOL and health state valuation techniques. Databases searched included MEDLINE,EMBASE,NHS EED,PsycINFO and ISI Web of Science. This review identified 12 studies that reported utility values associated with health states in AD. Values for AD health states categorized according to cognitive impairment (where 1 = perfect health and 0 = dead) ranged from mild AD (0.52-0.73) to moderate AD (0.30-0.53) to severe AD (0.12-0.49). Utility values were almost all based on two generic measures of HR-QOL: the EQ-5D and Health Utility Index mark 2/3 (HUI2/3). There were no health state values estimated from condition- or disease-specific measures of HR-QOL. The review also identified 18 published cost-utility analyses (CUAs) of treatments for AD. The CUAs incorporated results from only three of the identified health state valuation studies. Twelve CUAs relied on the same study for health state values. We conclude that the literature on health state values in AD is limited and overly reliant on a single symptom (cognition) to describe disease progression. Other approaches to characterizing disease progression in AD based on multiple outcomes or dependency may be better predictors of costs and utilities in economic evaluations. Patient and proxy ratings were poorly correlated,particularly in patients with more advanced AD. However,proxy ratings displayed the validity and reliability across the entire range of AD severity needed to detect long-term changes relevant to economic evaluation. Further longitudinal research of patient and carer HR-QOL based on multidimensional measures of outcome and utilities is needed."," Drugs Aging. 2012 Jan 1;29(1):31-43. ","International",2012,"Alzheimer’s","None or unclear",null,null,null,"Cost-utility",null,"International",null,"Alzheimer’s","None or unclear","Cost-utility",null,null,"2010:2014"]
[28,"Lachaine J,Beauchemin C,Legault M,Bineau S. Economic evaluation of the impact of memantine on time to nursing home admission in the treatment of Alzheimer disease. Can J Psychiatry. 2011 Oct;56(10):596-604. ",null,"Lachaine J,Beauchemin C,Legault M,Bineau S."," Economic evaluation of the impact of memantine on time to nursing home admission in the treatment of Alzheimer disease.","An observational study showed that combining memantine with a cholinesterase inhibitor (ChEI) treatment significantly delayed admission to nursing homes in patients with Alzheimer disease (AD). Our study aimed to evaluate the economic impact of the concomitant use of memantine and a ChEI,compared with a ChEI alone,in a Canadian population of patients with AD. A cost-utility analysis using a Markov model during a 7-year time horizon was performed according to a societal and Canadian health care system perspective. The Markov model includes the following states: noninstitutionalized,institutionalized,and deceased. The model includes transition probabilities for institutionalization and death,adjusted with mortality rates specific to AD. Utilities associated with institutionalization and noninstitutionalization were included. For the health care system perspective,costs of medication as well as costs of care provided in the community and in nursing homes were considered. For the societal perspective,costs of direct care and supervision provided by caregivers were added. From both perspectives,the concomitant use of a ChEI and memantine is a dominant strategy,compared with the use of a ChEI alone. On a per patient basis,there was a gain of 0.26 quality-adjusted life years with the treatment including memantine and cost decreases of Can$21 391 and Can$30 512,respectively,for the societal and health care system perspective. This economic evaluation indicates that institutionalization is the largest cost component in AD management and that the use of memantine,combined with a ChEI,to treat AD is a cost-effective alternative,compared with the use of a ChEI alone."," Can J Psychiatry. 2011 Oct;56(10):596-604. ","Canada",2011,"Alzheimer’s","Memantine",null,null,null,"Cost-utility",null,"Canada",null,"Alzheimer’s","Memantine","Cost-utility",null,null,"2010:2014"]
[29,"Charlesworth G,Burnell K,Beecham J,Hoare Z,Hoe J,Wenborn J,Knapp M,Russell I,Woods B,Orrell M. Peer support for family carers of people with dementia,alone or in combination with group reminiscence in a factorial design: study protocol for a randomised controlled trial. Trials. 2011 Sep 15;12():205. ","doi: 10.1186/1745-6215-12-205.","Charlesworth G,Burnell K,Beecham J,Hoare Z,Hoe J,Wenborn J,Knapp M,Russell I,Woods B,Orrell M."," Peer support for family carers of people with dementia,alone or in combination with group reminiscence in a factorial design: study protocol for a randomised controlled trial.","Peer support interventions can improve carer wellbeing and interventions that engage both the carer and person with dementia can have significant mutual benefits. Existing research has been criticised for inadequate rigour of design or reporting. This paper describes the protocol for a complex trial that evaluates one-to-one peer support and a group reminiscence programme,both separately and together,in a factorial design. A 2 × 2 factorial multi-site randomised controlled trial of individual peer support and group reminiscence interventions for family carers and people with dementia in community settings in England,addressing both effectiveness and cost-effectiveness. The methods described in this protocol have implications for research into psychosocial interventions,particularly complex interventions seeking to test both individual and group approaches."," Trials. 2011 Sep 15;12():205. ","UK",2011,"Any dementia","Support",null,null,null,"Unclear",null,"UK",null,"Any dementia","Support","Unclear",null,null,"2010:2014"]
[30,"Rive B,Aarsland D,Grishchenko M,Cochran J,Lamure M,Toumi M. Cost-effectiveness of memantine in moderate and severe Alzheimer's disease in Norway. Int J Geriatr Psychiatry. 2012 Jun;27(6):573-82. ","doi: 10.1002/gps.2755.","Rive B,Aarsland D,Grishchenko M,Cochran J,Lamure M,Toumi M."," Cost-effectiveness of memantine in moderate and severe Alzheimer's disease in Norway.","The cost-effectiveness of memantine for the treatment of moderate and severe Alzheimer's disease has been assessed in several European countries. Objective of the study was to assess it in Norwegian settings. This cost-utility analysis used a Markov modelling approach to simulate the evolution of patients until their need for full-time care (FTC) over a 5-year period. FTC was defined as a patient becoming either dependent or institutionalised. Transition probabilities were estimated using a newly developed predictive equation of time to FTC. Health resource use and utilities were obtained from the Scandinavian Study of Cost and Quality of Life in Alzheimer's Disease study,and mortality was obtained from the Oslo study. Memantine efficacy was based on a meta-analysis of six large trials. The model compared memantine with its alternative in this population,that is no pharmacological treatment or background therapy with acetylcholinesterase inhibitors. The model underwent extensive sensitivity analyses. In Norway,memantine was found to delay the need for FTC by 4.4 weeks compared with standard care and was associated with increased quality-adjusted life years. Memantine was the dominant strategy with cost savings of €3739 (30 041 NOK) per patient. The probability of being the dominant strategy was 98.8%. This result was confirmed across multiple sensitivity analyses. The model suggests that memantine prolongs time to FTC for no additional cost to the healthcare system and society. It can be regarded as a cost-effective choice in the management of moderate and severe Alzheimer's disease."," Int J Geriatr Psychiatry. 2012 Jun;27(6):573-82. ","Norway",2012,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility",null,"Norway",null,"Alzheimer’s","Any anticholinesterase,Memantine","Cost-utility",null,null,"2010:2014"]
[31,"Jones C,Edwards RT,Hounsome B. A systematic review of the cost-effectiveness of interventions for supporting informal caregivers of people with dementia residing in the community. Int Psychogeriatr. 2012 Jan;24(1):6-18. ","doi: 10.1017/S1041610211001207. ","Jones C,Edwards RT,Hounsome B."," A systematic review of the cost-effectiveness of interventions for supporting informal caregivers of people with dementia residing in the community.","Dementia places a huge demand on healthcare services; however,a large proportion of the cost is borne by informal caregivers. With the number of people affected by dementia set to increase in the future,there is a need for research to consider the effects of interventions on informal caregivers as well as on the individuals with dementia. This paper seeks to systematically review the existing evidence on the cost-effectiveness of interventions to support informal caregivers of people with dementia residing in the community. A range of electronic databases was searched. Studies were included if both costs and outcome measures for informal caregivers of people with dementia residing in the community were reported for an intervention. Both pharmacological and non-pharmacological interventions were included. Quality of study was assessed using the Drummond ten-item checklist for economic evaluations and results were presented through narrative synthesis. Twelve studies were included in the review; of these only four reported a significant difference in the outcome measure for caregivers. At present few published studies report costs in enough detail to provide evidence of the effectiveness and cost-effectiveness of interventions for supporting caregivers. Future trials need to collect caregiver data alongside patient data in order to increase the evidence base for intervention effectiveness. Further research is required to establish the effectiveness and cost-effectiveness of both pharmacological and non-pharmacological approaches."," Int Psychogeriatr. 2012 Jan;24(1):6-18. ","International",2012,"Any dementia","Support",null,null,null,"Unclear",null,"International",null,"Any dementia","Support","Unclear",null,null,"2010:2014"]
[32,"Zhang Y,Kivipelto M,Solomon A,Wimo A. Cost-effectiveness of a health intervention program with risk reductions for getting demented: results of a Markov model in a Swedish/Finnish setting. J Alzheimers Dis. 2011;26(4):735-44. ","doi: 10.3233/JAD-2011-110065. ","Zhang Y,Kivipelto M,Solomon A,Wimo A."," Cost-effectiveness of a health intervention program with risk reductions for getting demented: results of a Markov model in a Swedish/Finnish setting.","Risk scores based on modifiable factors have recently been developed for dementia. This study aims to estimate the cost-effectiveness of a potential preventive intervention program meant to lower the score related to increased dementia risk. Analyses were based on a Markov model adapted to Swedish circumstances. Risk score categories and risk probabilities were derived from the Cardiovascular Risk Factors,Aging and Incidence of Dementia (CAIDE) study in Finland. Figures of costs,utilities,and mortality were obtained from literature or databases. One-way sensitivity analysis and probabilistic sensitivity analysis were carried out to investigate the robustness of the model and to identify which model inputs had most impact on the results. In the base case,the usual care had a cost of 621,000 SEK and utilities of 11.8438 quality-adjusted life year (QALYs). The intervention had a cost of 599,026 SEK and utilities of 11.8950 QALYs. The cost was 21,974 SEK lower in the intervention with 0.0511 QALYs gained over a 20 years horizon,indicating absolute dominance. The support for cost-effectiveness was insensitive to changes in the value of QALY for demented,mortality,and risk of dementia. If the intervention program was assumed to run every year,the incremental cost-effectiveness ratio did not show absolute dominance but was still under the willingness-to-pay level. The probabilistic sensitivity analysis indicated cost effectiveness in 67% of the samplings given a willingness-to-pay level of 600,000 SEK/year. This is a promising outlook for future research on preventive interventions in dementia,emphasizing the need of conducting multi-domain randomized trials."," J Alzheimers Dis. 2011;26(4):735-44. ","Sweden,Finland",2011,"Any dementia","Prevention",null,null,null,"Cost-utility",null,"Sweden,Finland",null,"Any dementia","Prevention","Cost-utility",null,null,"2010:2014"]
[33,"Getsios D,Blume S,Ishak KJ,Maclaine G,Hernández L. An economic evaluation of early assessment for Alzheimer's disease in the United Kingdom. Alzheimers Dement. 2012 Jan;8(1):22-30. ","doi: 10.1016/j.jalz.2010.07.001. ","Getsios D,Blume S,Ishak KJ,Maclaine G,Hernández L."," An economic evaluation of early assessment for Alzheimer's disease in the United Kingdom.","Diagnosing and treating patients with Alzheimer's disease (AD) at an early stage should improve the quality of life of the patient and caregiver. In the United Kingdom,cost-effectiveness of early assessment of individuals presenting with subjective memory complaints and treating those with AD with donepezil was evaluated. A discrete event simulation of AD progression and the effect of treatment interventions was developed. Patient-level data from donepezil trials and a 7-year follow-up registry were used to model correlated longitudinal rates of change in cognition,behavior,and function. Other epidemiological and health services data,including estimates of undiagnosed dementia and delays in diagnosis,were based on published sources. Simulated individuals were followed up for 10 years. In the base-case estimates,17 patients need to be assessed to diagnose one patient with AD,resulting in an average assessment cost of £4100 ($6000; $1 US = £0.68 UK) per patient diagnosed (2007 cost year). In comparison with a scenario without early assessment or pharmacologic treatment,early assessment reduces health care costs by £3600 ($5300) per patient and societal costs by £7750 ($11,400). Savings are also substantial compared with treatment without early assessment,averaging £2100 ($3100) in health care costs,and £5700 ($8400) in societal costs. Results are most sensitive to estimates of patient care costs and the probability of patients reporting subjective memory complaints. In probabilistic sensitivity analysis,early assessment leads to savings or is highly cost-effective in the majority of cases. Although early assessment has significant up-front costs,identifying AD patients at an early stage results in cost savings and health benefits compared with no treatment or treatment in the absence of early assessment."," Alzheimers Dement. 2012 Jan;8(1):22-30. ","UK",2012,"Alzheimer’s","Diagnosis,Donepezil",null,null,null,"Cost-effectiveness",null,"UK",null,"Alzheimer’s","Diagnosis,Donepezil","Cost-effectiveness",null,null,"2010:2014"]
[34,"Cappell J,Herrmann N,Cornish S,Lanctôt KL. The pharmacoeconomics of cognitive enhancers in moderate to severe Alzheimer's disease. CNS Drugs. 2010 Nov;24(11):909-27. ","doi: 10.2165/11539530-000000000-00000.","Cappell J,Herrmann N,Cornish S,Lanctôt KL."," The pharmacoeconomics of cognitive enhancers in moderate to severe Alzheimer's disease.","Alzheimer's disease is associated with a substantial economic impact on patients,their caregivers and society. Due to the current rise in the aging population,the prevalence and impact of Alzheimer's disease are expected to increase greatly. The cost of caring for someone with Alzheimer's disease is magnified in the more severe stages of the disease. There are four cognitive enhancers commonly used for the treatment of Alzheimer's disease: three cholinesterase inhibitors (donepezil,rivastigmine and galantamine) and one NMDA receptor antagonist (memantine). Of these,donepezil and memantine have been approved in many countries as pharmacological treatments for moderate to severe Alzheimer's disease,while donepezil,rivastigmine and galantamine are approved treatments for mild to moderate Alzheimer's disease. While cost effectiveness has been well studied in mild to moderate Alzheimer's disease,the cost-benefit information for drug therapy in moderate to severe Alzheimer's disease is less clear. This article reviews the pharmacoeconomic data available on these four drugs,with a specific focus on moderate to severe Alzheimer's disease,including economic burden,cost drivers,clinical outcomes and pharmacoeconomic studies. A key driver of the cost of Alzheimer's disease is the severity of the disease,indicating that the ability to stabilize the disease state is a potential source of cost savings. Drug therapies that can limit increases in behavioural problems and cognitive and functional impairment,and postpone institutionalization without an increase in longevity may serve to reduce the economic burden on Alzheimer's disease patients. The data suggest that,while the available,approved agents offer only modest improvements in clinical outcomes,they could be cost-effective treatments for moderate to severe Alzheimer's disease when viewed from the societal perspective. For memantine and donepezil,data are available that suggest that the cost of these drugs is offset by the clinical and societal benefits provided by slowing the progression of Alzheimer's disease. While there are few head-to-head comparison trials,the similarity in costs of the treatments and efficacy against placebo suggest that cost effectiveness will not be substantially different among treatments. More studies that examine longitudinal resource utilization and its relationship to drug treatment in the moderate to severe stages are needed to clarify cost benefit in this population and possibly differentiate between individual medications."," CNS Drugs. 2010 Nov;24(11):909-27. ","International",2010,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine",null,null,null,"Unclear",null,"International",null,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine","Unclear",null,null,"2010:2014"]
[35,"Pitkala KH, Raivio MM, Laakkonen ML, Tilvis RS, Kautiainen H, Strandberg TE. Exercise rehabilitation on home-dwelling patients with Alzheimer's disease--a randomized, controlled trial. Study protocol. Trials. 2010 Oct 6;11():92. ","doi: 10.1186/1745-6215-11-92.","Pitkala KH, Raivio MM, Laakkonen ML, Tilvis RS, Kautiainen H, Strandberg TE."," Exercise rehabilitation on home-dwelling patients with Alzheimer's disease--a randomized, controlled trial.","Besides cognitive decline, Alzheimer's disease (AD) leads to physical disability, need for help and permanent institutional care. The trials investigating effects of exercise rehabilitation on physical functioning of home-dwelling older dementia patients are still scarce. The aim of this study is to investigate the effectiveness of intensive exercise rehabilitation lasting for one year on mobility and physical functioning of home-dwelling patients with AD. During years 2008-2010, patients with AD (n = 210) living with their spousal caregiver in community are recruited using central AD registers in Finland, and they are offered exercise rehabilitation lasting for one year. The patients are randomized into three arms: 1) tailored home-based exercise twice weekly 2) group-based exercise twice weekly in rehabilitation center 3) control group with usual care and information of exercise and nutrition. Main outcome measures will be Guralnik's mobility and balance tests and FIM-test to assess physical functioning. Secondary measures will be cognition, neuropsychiatric symptoms according to the Neuropsychiatric Inventory, caregivers' burden, depression and health-related quality of life (RAND-36). Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two year follow-up. To our knowledge this is the first large scale trial exploring whether home-dwelling patients with AD will benefit from intense and long-lasting exercise rehabilitation in respect to their mobility and physical functioning. It will also provide data on cost-effectiveness of the intervention. ACTRN12608000037303."," Study protocol. Trials. 2010 Oct 6;11():92. ","Finland",2010,"Alzheimer’s","Exercise",null,null,null,"Cost-utility",null,"Finland",null,"Alzheimer’s","Exercise","Cost-utility",null,null,"2010:2014"]
[36,"Gitlin LN, Hodgson N, Jutkowitz E, Pizzi L. The cost-effectiveness of a nonpharmacologic intervention for individuals with dementia and family caregivers: the tailored activity program. Am J Geriatr Psychiatry. 2010 Jun;18(6):510-9. ","doi: 10.1097/JGP.0b013e3181c37d13.","Gitlin LN, Hodgson N, Jutkowitz E, Pizzi L."," The cost-effectiveness of a nonpharmacologic intervention for individuals with dementia and family caregivers: the tailored activity program.","To evaluate cost-effectiveness of the Tailored Activity Program (TAP) for individuals with dementia and family caregivers. Cost-effectiveness study of a two-group randomized controlled trial involving 60 patients-caregiver dyads randomized to intervention or wait-list control. Participants' homes in Philadelphia region. Caregivers were aged ≥ 21 years, lived with patients, and provided ≥ 4 hours of daily care. Patients had moderate dementia and behavioral symptoms Eight sessions of occupational therapy over 4 months to identify patients' preserved capabilities, previous roles, habits and interests, develop customized activities, and train families in their use. Incremental cost-effectiveness ratios (ICER) expressed as the cost to bring about one additional unit of benefit measured by caregiver hours per day \"doing things\" and hours per day \"being on duty.\" Decision tree and Monte Carlo analyses tested robustness of the economic models. Total average intervention cost was $941.63 per day. Intervention caregivers saved one extra hour per day \"doing things\" at a cost of $2.37/day and one extra hour per day \"being on duty\" at a cost of $1.10/day. Monte Carlo showed that TAP was cost-effective 79.2% of the time for \"doing things\" and 79.6% of the time for \"being on duty.\" Varying the cost assumptions did not change cost-effectiveness. Findings suggest that investment in TAP is cost-effective and afforded families an important, limited and highly valued resource, needed time off from caregiving. This nonpharmacologic approach should be considered part of the clinical management of dementia."," Am J Geriatr Psychiatry. 2010 Jun;18(6):510-9. ","USA",2010,"Any dementia","Exercise",null,null,null,"Cost-effectiveness",null,"USA",null,"Any dementia","Exercise","Cost-effectiveness",null,null,"2010:2014"]
[37,"Nagy B, Brennan A, Brandtmüller A, Thomas SK, Sullivan SD, Akehurst R. Assessing the cost-effectiveness of the rivastigmine transdermal patch for Alzheimer's disease in the UK using MMSE- and ADL-based models. Int J Geriatr Psychiatry. 2011 May;26(5):483-94. ","doi: 10.1002/gps.2551. ","Nagy B, Brennan A, Brandtmüller A, Thomas SK, Sullivan SD, Akehurst R."," Assessing the cost-effectiveness of the rivastigmine transdermal patch for Alzheimer's disease in the UK using MMSE- and ADL-based models.","Assess long-term cost-effectiveness of rivastigmine patch in Alzheimer's disease (AD) management in the UK, using cognitive and functional models based on clinical trial efficacy data. Incremental costs and Quality Adjusted Life Years (QALYs) associated with rivastigmine patch and capsule treatment versus best supportive care (BSC) were calculated using two economic models, one based solely on Mini-Mental State Examination (MMSE) scores, and one also incorporating activities of daily living (ADL) scores. The clinical pathway was populated with data from a clinical trial of rivastigmine patch (9.5 mg/24 h) and capsules (12 mg/day) versus placebo. Costs were based on the UK health and social care costs and basic UK National Health Service (NHS) prices. Disease progression was modelled beyond the trial period over 5 years using published equations to predict natural decline in AD patients. Base case costing variables included drugs, clinical monitoring, and institutionalization. The MMSE model estimated incremental costs per QALY of £10 579 for rivastigmine patch and £15 154 for capsule versus BSC. The MMSE-ADL model estimated incremental costs per QALY of £9114 for rivastigmine patch and £13 758 for capsules. The main difference between the models was a greater number of institutionalized days avoided for rivastigmine versus BSC estimated by the MMSE-ADL model. Both the MMSE and MMSE-ADL models suggest that rivastigmine patch and capsules are cost-effective treatments versus BSC. Incorporating ADL evidence makes a marginal but important difference to estimates in this case. Future economic evaluations of AD treatment should include measures of both cognition and functioning."," Int J Geriatr Psychiatry. 2011 May;26(5):483-94. ","UK",2011,"Alzheimer’s","Rivastigmine",null,null,null,"Cost-utility",null,"UK",null,"Alzheimer’s","Rivastigmine","Cost-utility",null,null,"2010:2014"]
[38,"Suh GH. Modeling the cost-effectiveness of galantamine for mild to moderately severe Alzheimer's disease in Korea. Value Health. 2009 Nov-Dec;12 Suppl 3():S49-54. ","doi: 10.1111/j.1524-4733.2009.00627.x.","Suh GH."," Modeling the cost-effectiveness of galantamine for mild to moderately severe Alzheimer's disease in Korea.","The aim of the study was to determine the cost-effectiveness, from the third-party payer viewpoint, of galantamine compared with usual care in the treatment of mild to moderately severe Alzheimer's disease (AD). An existing Markov model was adapted to Korea to predict long-term outcomes over a 5-year time horizon and to estimate the cost-effectiveness of galantamine for the treatment of AD. The model structure is informed by a review of national and international literature on the clinical and cost-effectiveness of galantamine and on the costs and outcomes associated with treatment for AD. The main outcome measure used was the cost per quality-adjusted life year (QALY) gained. All costs were indexed to US$ (2007 value). Multivariate probabilistic sensitivity analysis and scenario analysis were undertaken to assess uncertainty in the results. The study findings indicate that the clinical benefits on AD progression from galantamine treatment resulted in an incremental cost per QALY gained of US$4939 over 5 years (vs. usual care). Probabilistic sensitivity analysis and cost-effectiveness acceptability curve suggest that the probability of galantamine treatment having an incremental cost per QALY over US$6740 is zero. Incremental cost per QALY gained according to scenario analyses ranged from US$2271 to US$8335. These findings suggest that the use of galantamine may be a cost-effective use of Korean national health-care resources, considering the gross domestic product per capita of US$21,695 in 2007."," Value Health. 2009 Nov-Dec;12 Suppl 3():S49-54. ","Korea",2009,"Alzheimer’s","Galantamine",null,null,null,"Cost-utility",null,"Korea",null,"Alzheimer’s","Galantamine","Cost-utility",null,null,"2005:2009"]
[39,"Rive B, Grishchenko M, Guilhaume-Goulant C, Katona C, Livingston G, Lamure M, Toumi M, François C. Cost effectiveness of memantine in Alzheimer's disease in the UK. J Med Econ. 2010;13(2):371-80. ","doi: 10.3111/13696998.2010.491347","Rive B, Grishchenko M, Guilhaume-Goulant C, Katona C, Livingston G, Lamure M, Toumi M, François C."," Cost effectiveness of memantine in Alzheimer's disease in the UK.","This analysis assesses the cost-effectiveness of memantine for the treatment of moderate-to-severe Alzheimer's disease (AD) in the UK. This cost-utility analysis was based on a Markov model. The model simulated 5-year progress of patients with AD until they need full-time care (FTC), defined as a patient becoming either dependent or institutionalised. Transition probabilities were based on a predictive equation, derived from the London and South-East Region epidemiological study. Resource use, utilities and mortality were obtained from the same study. Memantine efficacy was based on a meta-analysis of six large trials. The model compared memantine to its alternative in the UK, i.e. no pharmacological treatment or background therapy with acetylcholinesterase inhibitors. Memantine was found to delay the need to FTC by 6 weeks compared with current practice in the UK. It was associated with increased quality-adjusted life-years and cost savings to the healthcare system (probability of this outcome was 96%). The projections were made assuming that benefits from the 6-month treatment were sustained over time, which is regarded as the main limitation. The model underwent extensive sensitivity analyses, which confirmed the base-case findings. The model suggests that memantine delays the need for FTC and decreases cost. It can be regarded as a cost-effective choice in the management of moderate and severe AD."," J Med Econ. 2010;13(2):371-80. ","UK",2010,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility",null,"UK",null,"Alzheimer’s","Any anticholinesterase,Memantine","Cost-utility",null,null,"2010:2014"]
[40,"Getsios D, Blume S, Ishak KJ, Maclaine GD. Cost effectiveness of donepezil in the treatment of mild to moderate Alzheimer's disease: a UK evaluation using discrete-event simulation. Pharmacoeconomics. 2010;28(5):411-27. ","doi: 10.2165/11531870-000000000-00000. ","Getsios D, Blume S, Ishak KJ, Maclaine GD."," Cost effectiveness of donepezil in the treatment of mild to moderate Alzheimer's disease: a UK evaluation using discrete-event simulation.","Recommendations in the UK suggest restricting treatment of Alzheimer's disease with cholinesterase inhibitors, on cost-effectiveness grounds, to patients with moderate cognitive decline. As the economic analyses that informed these recommendations have been the subject of debate, we sought to address the potential limitations of existing models and produce estimates of donepezil treatment cost effectiveness in the UK using the most recent available data and simulation techniques. A discrete-event simulation was developed that predicts progression of Alzheimer's disease through correlated changes in cognition, behavioural disturbance and function. Patient-level data from seven randomized, placebo-controlled donepezil trials and a 7-year follow-up registry provided the basis for modeling longitudinal outcomes. Individuals in the simulation were assigned unique demographic and clinical characteristics and then followed for 10 years, with severity of disease tracked on continuous scales. Patient mix and costs were developed from UK-specific literature. Analyses were run for severity subgroups to evaluate outcomes for sub-populations with disease of mild versus moderate severity from both a healthcare payer and societal perspective. All costs are reported in pound, year 2007 values, and all outcomes are discounted at 3.5% per annum. Over 10 years, treatment of all patients with mild to moderate disease reduces overall direct medical costs by an average of over pound2300 per patient. When unpaid caregiver time is also taken into consideration, savings increase to over pound4700 per patient. Compared with untreated patients, patients receiving donepezil experience a discounted gain in QALYs averaging 0.11, with their caregivers gaining, on average, 0.01 QALYs. For the subset of patients starting treatment with more severe disease, savings are more modest, averaging about pound1600 and pound3750 from healthcare and societal perspectives, respectively. In probabilistic sensitivity analyses, donepezil dominated no treatment between 57% and 62% of replications when only medical costs were considered, and between 74% and 79% of replications when indirect costs were included, with results more favourable for treatment initiation in the mild versus moderate severity stages of the disease. Although the simulation results are not definitive, they suggest that donepezil leads to health benefits and cost savings when used to treat mild to moderately severe Alzheimer's disease in the UK. They also indicate that both benefits and savings may be greatest when treatment is started while patients are still in the mild stages of Alzheimer's disease."," Pharmacoeconomics. 2010;28(5):411-27. ","UK",2010,"Alzheimer’s","Donepezil",null,null,null,"Cost-utility",null,"UK",null,"Alzheimer’s","Donepezil","Cost-utility",null,null,"2010:2014"]
[41,"Jones R, Sheehan B, Phillips P, Juszczak E, Adams J, Baldwin A, Ballard C, Banerjee S, Barber B, Bentham P, Brown R, Burns A, Dening T, Findlay D, Gray R, Griffin M, Holmes C, Hughes A, Jacoby R, Johnson T, Jones R, Knapp M, Lindesay J, McKeith I, McShane R, Macharouthu A, O'Brien J, Onions C, Passmore P, Raftery J, Ritchie C, Howard R, DOMINO-AD team. DOMINO-AD protocol: donepezil and memantine in moderate to severe Alzheimer's disease - a multicentre RCT. Trials. 2009 Jul 24;10():57. ","doi: 10.1186/1745-6215-10-57. ","Jones R, Sheehan B, Phillips P, Juszczak E, Adams J, Baldwin A, Ballard C, Banerjee S, Barber B, Bentham P, Brown R, Burns A, Dening T, Findlay D, Gray R, Griffin M, Holmes C, Hughes A, Jacoby R, Johnson T, Jones R, Knapp M, Lindesay J, McKeith I, McShane R, Macharouthu A, O'Brien J, Onions C, Passmore P, Raftery J, Ritchie C, Howard R, DOMINO-AD team."," DOMINO-AD protocol: donepezil and memantine in moderate to severe Alzheimer's disease - a multicentre RCT.","Alzheimer's disease (AD) is the commonest cause of dementia. Cholinesterase inhibitors, such as donepezil, are the drug class with the best evidence of efficacy, licensed for mild to moderate AD, while the glutamate antagonist memantine has been widely prescribed, often in the later stages of AD. Memantine is licensed for moderate to severe dementia in AD but is not recommended by the England and Wales National Institute for Health and Clinical Excellence. However, there is little evidence to guide clinicians as to what to prescribe as AD advances; in particular, what to do as the condition progresses from moderate to severe. Options include continuing cholinesterase inhibitors irrespective of decline, adding memantine to cholinesterase inhibitors, or prescribing memantine instead of cholinesterase inhibitors. The aim of this trial is to establish the most effective drug option for people with AD who are progressing from moderate to severe dementia despite treatment with donepezil. DOMINO-AD is a pragmatic, 15 centre, double-blind, randomized, placebo controlled trial. Patients with AD, currently living at home, receiving donepezil 10 mg daily, and with Standardized Mini-Mental State Examination (SMMSE) scores between 5 and 13 are being recruited. Each is randomized to one of four treatment options: continuation of donepezil with memantine placebo added; switch to memantine with donepezil placebo added; donepezil and memantine together; or donepezil placebo with memantine placebo. 800 participants are being recruited and treatment continues for one year. Primary outcome measures are cognition (SMMSE) and activities of daily living (Bristol Activities of Daily Living Scale). Secondary outcomes are non-cognitive dementia symptoms (Neuropsychiatric Inventory), health related quality of life (EQ-5D and DEMQOL-proxy), carer burden (General Health Questionnaire-12), cost effectiveness (using Client Service Receipt Inventory) and institutionalization. These outcomes are assessed at baseline, 6, 18, 30 and 52 weeks. All participants will be subsequently followed for 3 years by telephone interview to record institutionalization. There is considerable debate about the clinical and cost effectiveness of anti-dementia drugs. DOMINO-AD seeks to provide clear evidence on the best treatment strategies for those managing patients at a particularly important clinical transition point. Current controlled trials ISRCTN49545035."," Trials. 2009 Jul 24;10():57. ","UK",2009,"Alzheimer’s","Donepezil,Memantine",null,null,null,"Unclear",null,"UK",null,"Alzheimer’s","Donepezil,Memantine","Unclear",null,null,"2005:2009"]
[42,"Weimer DL, Sager MA. Early identification and treatment of Alzheimer's disease: social and fiscal outcomes. Alzheimers Dement. 2009 May;5(3):215-26. ","doi: 10.1016/j.jalz.2009.01.028.","Weimer DL, Sager MA."," Early identification and treatment of Alzheimer's disease: social and fiscal outcomes.","Alzheimer's disease (AD) is a progressive neurodegenerative disease that places substantial burdens on those who provide support for family members with declining cognitive and functional abilities. Many AD patients eventually require formal long-term care services because of the absence, exhaustion, or inability of family members to provide care. The costs of long-term care, and especially nursing home care, often deplete private financial resources, placing a substantial burden on state Medicaid programs. Current evidence suggests that pharmacological treatments and caregiver interventions can delay entry into nursing homes and potentially reduce Medicaid costs. However, these cost savings are not being realized because many patients with AD are either not diagnosed or diagnosed at late stages of the disease, and have no access to Medicare-funded caregiver support programs. A Monte Carlo cost-benefit analysis, based on estimates of parameters available in the medical literature, suggests that the early identification and treatment of AD have the potential to result in large, positive net social benefits as well as positive net savings for states and the federal government. These findings indicate that the early diagnosis and treatment of AD are not only socially desirable in terms of increasing economic efficiency, but also fiscally attractive from both state and federal perspectives. These findings also suggest that failure to fund effective caregiver interventions may be fiscally unsound."," Alzheimers Dement. 2009 May;5(3):215-26. ","USA",2009,"Alzheimer’s","Diagnosis",null,null,null,"Cost-benefit",null,"USA",null,"Alzheimer’s","Diagnosis","Cost-benefit",null,null,"2005:2009"]
[43,"Meeuwsen EJ, German P, Melis RJ, Adang EM, Golüke-Willemse GA, Krabbe PF, de Leest BJ, van Raak FH, Schölzel-Dorenbos CJ, Visser MC, Wolfs CA, Vliek S, Rikkert MG. Cost-effectiveness of post-diagnosis treatment in dementia coordinated by Multidisciplinary Memory Clinics in comparison to treatment coordinated by general practitioners: an example of a pragmatic trial. J Nutr Health Aging. 2009 Mar;13(3):242-8.",null,"Meeuwsen EJ, German P, Melis RJ, Adang EM, Golüke-Willemse GA, Krabbe PF, de Leest BJ, van Raak FH, Schölzel-Dorenbos CJ, Visser MC, Wolfs CA, Vliek S, Rikkert MG."," Cost-effectiveness of post-diagnosis treatment in dementia coordinated by Multidisciplinary Memory Clinics in comparison to treatment coordinated by general practitioners: an example of a pragmatic trial.","With the rising number of dementia patients with associated costs and the recognition that there is room for improvement in the provision of dementia care, the question arises on how to efficiently provide high quality dementia care. To describe the design of a study to determine multidisciplinary memory clinics' (MMC) effectiveness and cost-effectiveness in post-diagnosis treatment and care-coordination of dementia patients and their caregivers compared to the post-diagnosis treatment and care-coordination by general practitioners (GP). Next, this article provides the theoretical background of pragmatic trials, often needed in complex interventions, with the AD- Euro study as an example of such a pragmatic approach in a clinical trial. The study is a pragmatic multicentre, randomised clinical trial with an economic evaluation alongside, which aims to recruit 220 independently living patients with a new dementia diagnosis and their informal caregivers. After baseline measurements, patient and caregiver are allocated to the treatment arm MMC or GP and are visited for follow up measurements at 6 and 12 months. Primary outcome measures are Health Related Quality of Life of the patient as rated by the caregiver using the Quality of Life in Alzheimer's Disease instrument (Qol-AD) and self-perceived caregiving burden of the informal caregiver measured using the Sense of Competence Questionnaire (SCQ). To establish cost-effectiveness a cost-utility analysis using utilities generated by the EuroQol instrument (EQ-5D) will be conducted from a societal perspective. Analyses will be done in an intention-to-treat fashion. The inclusion period started in January 2008 and will commence until at least December 2008. After finalising follow up the results of the study are expected to be available halfway through 2010. The study will provide an answer to whether follow-up of dementia patients can best be done in specialised outpatient memory clinics or in primary care settings with regard to quality and costs. It will enable decision making on how to provide good and efficient health care services in dementia. ClinicalTrials.gov Identifier NCT00554047."," J Nutr Health Aging. 2009 Mar;13(3):242-8.","Netherlands",2009,"Any dementia","Memory clinic",null,null,null,"Cost-utility",null,"Netherlands",null,"Any dementia","Memory clinic","Cost-utility",null,null,"2005:2009"]
[44,"Suh GH, Han C. Mental health economics, health service provision, and the practice of geriatric psychiatry. Curr Opin Psychiatry. 2008 Nov;21(6):546-50. ","doi: 10.1097/YCO.0b013e32830f1bd5.","Suh GH, Han C."," Mental health economics, health service provision, and the practice of geriatric psychiatry.","Economic evaluation is becoming more and more important as a means to assist policy makers in choosing the best intervention or treatment against a pervasive scarcity of resources relative to the demands. Health service provision and the practice of geriatric psychiatry are closely associated with costs and outcomes of health economics. Recently published literature raising unanswered questions in these areas is reviewed. Some studies on the costs, outcomes, and cost-effectiveness of certain interventions or treatments (e.g. respite care, home-visiting community service) compared with usual strategies show that these are not optimal in terms of health economics. The updated guidance by the National Institute for Health and Clinical Excellence that cholinesterase inhibitors should be used only for moderate severity dementia on the grounds of cost-effectiveness has been heavily criticized. Mental health provision for older people varies across 'developed' and 'developing' countries. Updated findings provide better understanding of recent progress and issues on mental health economics, health service provision, and the practice of geriatric psychiatry. The application of health economics to the field of mental health should make complicated issues simple and explicit. Constructive criticisms and scientific debates will hasten the development of better tools or methodologies to evaluate the cost-effectiveness of current and new interventions or treatments."," Curr Opin Psychiatry. 2008 Nov;21(6):546-50. ","International",2008,"Any dementia","Any anticholinesterase",null,null,null,"Unclear",null,"International",null,"Any dementia","Any anticholinesterase","Unclear",null,null,"2005:2009"]
[45,"Webert KE, Cserti CM, Hannon J, Lin Y, Pavenski K, Pendergrast JM, Blajchman MA. Proceedings of a Consensus Conference: pathogen inactivation-making decisions about new technologies. Transfus Med Rev. 2008 Jan;22(1):1-34. ","doi: 10.1016/j.tmrv.2007.09.001.","Webert KE, Cserti CM, Hannon J, Lin Y, Pavenski K, Pendergrast JM, Blajchman MA."," Proceedings of a Consensus Conference: pathogen inactivation-making decisions about new technologies.","Significant progress has been made in reducing the risk of pathogen transmission to transfusion recipients. Nonetheless, there remains a continuing risk of transmission of viruses, bacteria, protozoa, and prions to recipients. These include many of the viruses for which specific screening tests exist as well as pathogens for which testing is currently not being done, including various species of bacteria, babesiosis, variant Creutzfeld-Jacob disease, hepatitis A virus, human herpes virus 8, chikungunya virus, Chagas disease, and malaria. Pathogen inactivation (PI) technologies potentially provide an additional way to protect the blood supply from emerging agents and also provide additional protection against both known and as-yet-unidentified agents. However, the impact of PI on product quality and recipient safety remains to be determined. The purpose of this consensus conference was to bring together international experts in an effort to consider the following issues with respect to PI: implementation criteria; licensing requirements; blood service and clinical issues; risk management issues; cost-benefit impact; and research requirements. These proceedings are provided to make available to the transfusion medicine community the considerable amount of important information presented at this consensus conference."," Transfus Med Rev. 2008 Jan;22(1):1-34. ","International",2008,"CJD","Prevention",null,null,null,"Unclear",null,"International",null,"CJD","Prevention","Unclear",null,null,"2005:2009"]
[46,"Wartenberg D. EMFs: cutting through the controversy. Public Health Rep. 1996 May-Jun;111(3):204-17. ",null,"Wartenberg D."," EMFs: cutting through the controversy.","SOME SCIENTISTS ALLEGE that exposure to electric and magnetic fields generated by electric power delivery systems is responsible for certain cancers (particularly among children), reproductive dysfunction, birth defects, neurological disorders, and Alzheimer's disease. Some activist groups believe the hazard to be so great that they are calling for closure of schools and other public facilities near power lines and restructuring of the entire electric power delivery system. Some utilities, with equally strong beliefs, claim that there is no proof of risk. They argue that the science is sufficient to confirm the alleged associations and that no action is warranted. This article provides a broad overview of the current scientific data on the association between magnetic fields and disease, providing summary risk estimates and highlighting the uncertainties in the data. Building on this information, three complementary policy perspectives are presented. From a fiscally conservative perspective, the cost of mitigation already instituted far exceeds the health protection offered and mitigation of other environmental risks is more important. From a cost-benefit view, only limited, low-cost mitigation should be considered. These measures, however, would substantially reduce many exposures. From an aggressive exposure reduction perspective, much can be done to reduce exposure by personal and societal actions. If the suggested association is validated, substantially reducing magnetic field exposure could lower health risks."," Public Health Rep. 1996 May-Jun;111(3):204-17. ","Unknown",1996,"Alzheimer’s","Prevention",null,null,null,"Cost-benefit",null,"Unknown",null,"Alzheimer’s","Prevention","Cost-benefit",null,null,"1960:1999"]
[47,"van Knippenberg RJ, de Vugt ME, Ponds RW, Myin-Germeys I, Verhey FR. Dealing with daily challenges in dementia (deal-id study): effectiveness of the experience sampling method intervention 'Partner in Sight' for spousal caregivers of people with dementia: design of a randomized controlled trial. BMC Psychiatry. 2016 May 11;16():136. ","doi: 10.1186/s12888-016-0834-5. ","van Knippenberg RJ, de Vugt ME, Ponds RW, Myin-Germeys I, Verhey FR."," Dealing with daily challenges in dementia (deal-id study): effectiveness of the experience sampling method intervention 'Partner in Sight' for spousal caregivers of people with dementia: design of a randomized controlled trial.","There is an urgent need for psychosocial interventions that effectively support dementia caregivers in daily life. The Experience Sampling Methodology (ESM) offers the possibility to provide a more dynamic view of caregiver functioning. ESM-derived feedback may help to redirect caregivers' behavior towards situations that elicit positive emotions and to increase their feelings of competence in the caretaking process. This paper presents the design of a study that evaluates the process characteristics and effects of the ESM-based intervention 'Partner in Sight'. A randomized controlled trial with 90 spousal caregivers of people with dementia will be conducted. Participants will be randomly assigned to the experimental (6-week ESM intervention including feedback), pseudo-experimental (6-week ESM intervention without feedback), or control group (care as usual). Assessments will be performed pre- and post-intervention and at 2-, and 6-month follow-up. Main outcomes will be sense of competence, perceived control, momentary positive affect, and psychological complaints (depressive symptoms, perceived stress, anxiety, momentary negative affect). In addition to the effect evaluation, a process and economic evaluation will be conducted to investigate the credibility and generalizability of the intervention, and its cost-effectiveness. The potential effects of the ESM intervention may help caregivers to endure their care responsibilities and prevent them from becoming overburdened. This is the first ESM intervention for caregivers of people with dementia. The results of this study, therefore, provide a valuable contribution to the growing knowledge on m-health interventions for dementia caregivers. Dutch Trial Register NTR4847 ; date registered Oct 9, 2014."," BMC Psychiatry. 2016 May 11;16():136. ","Netherlands",2016,"Any dementia","Support",null,null,null,"Unclear",null,"Netherlands",null,"Any dementia","Support","Unclear",null,null,"2015:2017"]
[48,"de Souto Barreto P, Denormandie P, Lepage B, Armaingaud D, Rapp T, Chauvin P, Vellas B, Rolland Y. Effects of a long-term exercise programme on functional ability in people with dementia living in nursing homes: Research protocol of the LEDEN study, a cluster randomised controlled trial. Contemp Clin Trials. 2016 Mar;47():289-95. ","doi: 10.1016/j.cct.2016.02.004.","de Souto Barreto P, Denormandie P, Lepage B, Armaingaud D, Rapp T, Chauvin P, Vellas B, Rolland Y."," Effects of a long-term exercise programme on functional ability in people with dementia living in nursing homes: Research protocol of the LEDEN study, a cluster randomised controlled trial.","Exercise may lead to improvements on functional ability, physical function, and neuropsychiatric symptoms (particularly depression) in people with dementia (PWD). However, high-quality randomised controlled trial (RCT), controlling for the socialisation aspect of group-based exercise interventions, and designed to delay the declines on the functional ability of PWD in the nursing home (NH) setting is almost inexistent. This article describes the protocol of the LEDEN study, an exercise RCT for PWD living in NHs. LEDEN is a cluster-randomised controlled pilot trial composed of two research arms: exercise training (experimental group) and social/recreational activity (control group). Both interventions will be provided twice a week, for 60 min, during the 6-month intervention. The total duration of the study is 12 months, being six months of intervention plus six months of observational follow-up. Eight French NHs volunteered to participate in LEDEN; they have been randomised to either exercise intervention or social/recreational intervention in a 1:1 ratio. The primary objective is to investigate the effects of exercise, compared to a social/recreational intervention, on the ability of PWD living in NHs to perform activities of daily living (ADL). Secondary objectives are related with the cost-effectiveness of the interventions, and the effects of the interventions on patients' physical function, neuropsychiatric symptoms, pain, nutritional status, and the incidence of falls and fractures. LEDEN will provide the preliminary evidence needed to inform the development of larger and more complex interventions using exercise or non-exercise social interventions."," Contemp Clin Trials. 2016 Mar;47():289-95. ","France",2016,"Any dementia","Exercise",null,null,null,"Unclear",null,"France",null,"Any dementia","Exercise","Unclear",null,null,"2015:2017"]
[49,"Tanajewski L, Franklin M, Gkountouras G, Berdunov V, Harwood RH, Goldberg SE, Bradshaw LE, Gladman JR, Elliott RA. Economic Evaluation of a General Hospital Unit for Older People with Delirium and Dementia (TEAM Randomised Controlled Trial). PLoS One. 2015;10(12):e0140662. ","doi: 10.1371/journal.pone.0140662. ","Tanajewski L, Franklin M, Gkountouras G, Berdunov V, Harwood RH, Goldberg SE, Bradshaw LE, Gladman JR, Elliott RA."," Economic Evaluation of a General Hospital Unit for Older People with Delirium and Dementia (TEAM Randomised Controlled Trial).","One in three hospital acute medical admissions is of an older person with cognitive impairment. Their outcomes are poor and the quality of their care in hospital has been criticised. A specialist unit to care for older people with delirium and dementia (the Medical and Mental Health Unit, MMHU) was developed and then tested in a randomised controlled trial where it delivered significantly higher quality of, and satisfaction with, care, but no significant benefits in terms of health status outcomes at three months. To examine the cost-effectiveness of the MMHU for older people with delirium and dementia in general hospitals, compared with standard care. Six hundred participants aged over 65 admitted for acute medical care, identified on admission as cognitively impaired, were randomised to the MMHU or to standard care on acute geriatric or general medical wards. Cost per quality adjusted life year (QALY) gained, at 3-month follow-up, was assessed in trial-based economic evaluation (599/600 participants, intervention: 309). Multiple imputation and complete-case sample analyses were employed to deal with missing QALY data (55%). The total adjusted health and social care costs, including direct costs of the intervention, at 3 months was £7714 and £7862 for MMHU and standard care groups, respectively (difference -£149 (95% confidence interval [CI]: -298, 4)). The difference in QALYs gained was 0.001 (95% CI: -0.006, 0.008). The probability that the intervention was dominant was 58%, and the probability that it was cost-saving with QALY loss was 39%. At £20,000/QALY threshold, the probability of cost-effectiveness was 94%, falling to 59% when cost-saving QALY loss cases were excluded. The MMHU was strongly cost-effective using usual criteria, although considerably less so when the less acceptable situation with QALY loss and cost savings were excluded. Nevertheless, this model of care is worthy of further evaluation. ClinicalTrials.gov NCT01136148."," PLoS One. 2015;10(12):e0140662. ","UK",2015,"Any dementia","Disease management",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Disease management","Cost-utility",null,null,"2015:2017"]
[50,"Saint-Laurent Thibault C, Özer Stillman I, Chen S, Getsios D, Proskorovsky I, Hernandez L, Dixit S. Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer's type in the US. J Med Econ. 2015;18(11):930-43. ","doi: 10.3111/13696998.2015.1063501.","Saint-Laurent Thibault C, Özer Stillman I, Chen S, Getsios D, Proskorovsky I, Hernandez L, Dixit S."," Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer's type in the US.","This study evaluates the cost-effectiveness of memantine extended release (ER) as an add-on therapy to acetylcholinesterase inhibitor (AChEI) [combination therapy] for treatment of patients with moderate-to-severe Alzheimer's disease (AD) from both a healthcare payer and a societal perspective over 3 years when compared to AChEI monotherapy in the US. A phase III trial evaluated the efficacy and safety of memantine ER for treatment of AD patients taking an AChEI. The analysis assessed the long-term costs and health outcomes using an individual patient simulation in which AD progression is modeled in terms of cognition, behavior, and functioning changes. Input parameters are based on patient-level trial data, published literature, and publicly available data sources. Changes in anti-psychotic medication use are incorporated based on a published retrospective cohort study. Costs include drug acquisition and monitoring, total AD-related medical care, and informal care associated with caregiver time. Incremental cost-utility ratio (ICUR), life years, care time for caregiver, time in community and institution, time on anti-psychotics, time by disease severity, and time without severe symptoms are reported. Costs and health outcomes are discounted at 3% per annum. Considering a societal perspective over 3 years, this analysis shows that memantine ER combined with an AChEI provides better clinical outcomes and lower costs than AChEI monotherapy. Discounted average savings were estimated at $18,355 and $20,947 per patient and quality-adjusted life-years (QALYs) increased by an average of 0.12 and 0.13 from a societal and healthcare payer perspective, respectively. Patients on combination therapy spent an average of 4 months longer living at home and spend less time in moderate-severe and severe stages of the disease. Combination therapy for patients with moderate-to-severe AD is a cost-effective treatment compared to AChEI monotherapy in the US."," J Med Econ. 2015;18(11):930-43. ","USA",2015,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility",null,"USA",null,"Alzheimer’s","Any anticholinesterase,Memantine","Cost-utility",null,null,"2015:2017"]
[51,"Handels RL, Joore MA, Tran-Duy A, Wimo A, Wolfs CA, Verhey FR, Severens JL. Early cost-utility analysis of general and cerebrospinal fluid-specific Alzheimer's disease biomarkers for hypothetical disease-modifying treatment decision in mild cognitive impairment. Alzheimers Dement. 2015 Aug;11(8):896-905. ","doi: 10.1016/j.jalz.2015.02.009. ","Handels RL, Joore MA, Tran-Duy A, Wimo A, Wolfs CA, Verhey FR, Severens JL."," Early cost-utility analysis of general and cerebrospinal fluid-specific Alzheimer's disease biomarkers for hypothetical disease-modifying treatment decision in mild cognitive impairment.","The study aimed to determine the room for improvement of a perfect cerebrospinal fluid (CSF) biomarker and the societal incremental net monetary benefit of CSF in subjects with mild cognitive impairment (MCI) assuming a hypothetical disease-modifying Alzheimer's disease (AD) treatment. A decision model compared current practice to a perfect biomarker and to two strategies positioning CSF as add-on test when current practice concluded the presence or absence of AD. The simulated MCI population was aged on average 68.3 and 49% had AD. The room for improvement by the perfect CSF test was 0.39 quality adjusted life years, €33,622 ($43,372) savings, 2.0 potential beneficial treatment years, and 1.3-year delay in dementia conversion. The results indicated more potential benefit from a biomarker positioned to verify subjects who are not expected to have AD (i.e., to prevent undertreatment) rather than to verify subjects expected to have AD (prevent overtreatment). Sensitivity analyses explored different CSF positions."," Alzheimers Dement. 2015 Aug;11(8):896-905. ","Netherlands",2015,"Alzheimer’s","Diagnosis",null,null,null,"Cost-utility",null,"Netherlands",null,"Alzheimer’s","Diagnosis","Cost-utility",null,null,"2015:2017"]
[52,"Krol M, Papenburg J, van Exel J. Does including informal care in economic evaluations matter? A systematic review of inclusion and impact of informal care in cost-effectiveness studies. Pharmacoeconomics. 2015 Feb;33(2):123-35. ","doi: 10.1007/s40273-014-0218-y. ","Krol M, Papenburg J, van Exel J."," Does including informal care in economic evaluations matter? A systematic review of inclusion and impact of informal care in cost-effectiveness studies.","Informal care makes an important contribution to societal welfare. However, it may involve substantial time costs and can have a considerable negative effect on the health and well-being of informal caregivers. These costs and effects of informal caregiving are often excluded in economic evaluations of healthcare interventions. The impact of this exclusion on the outcomes of these evaluations is largely unknown. This study aimed to explore the inclusion of informal care in economic evaluations and the potential impact of the costs and effects of informal caregiving on cost-effectiveness outcomes. A systematic review was conducted to identify economic evaluations of interventions in four distinct disease areas where informal care is potentially important: Alzheimer's disease, metastatic colorectal cancer, Parkinson's disease and rheumatoid arthritis. It was recorded how often economic evaluations included informal caregiving. Next, for the studies including informal care, the impact on cost-effectiveness outcomes was determined by removing informal care costs and effects of the cost-effectiveness calculations and recalculating the outcomes. The new cost-effectiveness outcomes were then compared with the original reported outcomes. The study identified 100 economic evaluations investigating interventions targeted at Alzheimer's disease (n = 25), metastatic colorectal cancer (n = 24), Parkinson's disease (n = 8) and rheumatoid arthritis (n = 43). Twenty-three of these evaluations (23 %) included costs and/or effects of informal caregiving: 64 % of the Alzheimer's disease studies, 0 % of the metastatic colorectal cancer studies, 13 % of Parkinson's disease studies and 14 % of rheumatoid arthritis studies. When informal care was included, this mostly concerned time costs. Studies rarely included both costs and effects. The effect of including or excluding informal care costs or effects on cost-effectiveness outcomes in most studies was modest, but in some studies the impact was strong. Most economic evaluations in the area of Alzheimer's disease include costs and/or effects related to informal caregiving. However, in other disease areas where informal caregiving is common it seems that the majority of economic evaluations ignore informal caregiving. The inclusion of informal care can have a strong impact on cost-effectiveness outcomes. Future economic evaluations should therefore consider the relevance of informal care in the context of their study, and either include these costs and effects or justify why they were excluded."," Pharmacoeconomics. 2015 Feb;33(2):123-35. ","International",2015,"Alzheimer’s","Informal care",null,null,null,"Unclear",null,"International",null,"Alzheimer’s","Informal care","Unclear",null,null,"2015:2017"]
[53,"Dixon J, Ferdinand M, D'Amico F, Knapp M. Exploring the cost-effectiveness of a one-off screen for dementia (for people aged 75 years in England and Wales). Int J Geriatr Psychiatry. 2015 May;30(5):446-52. ","doi: 10.1002/gps.4158. ","Dixon J, Ferdinand M, D'Amico F, Knapp M."," Exploring the cost-effectiveness of a one-off screen for dementia (for people aged 75 years in England and Wales).","This paper examines the numbers of people with dementia who could be diagnosed and the likely cost-effectiveness of a one-off screen for dementia for people aged 75 years in England and Wales. The study uses static decision modelling to compare a one-off screen for dementia with a no-screen scenario. Estimates for the model were drawn from systematic reviews, high-quality studies and government and administrative sources. A panel of experts also advised the study. An estimated 3514 people could be diagnosed as a result of screening, 2152 of whom would otherwise never receive a diagnosis. The study identified societal economic impact of between £3,649,794 (net costs) and £4,685,768 (net savings), depending on assumptions. Our analysis suggests that screening could be cost-effective, especially as treatments and social care interventions become more effective and if diagnosis by current routes remains low or occurs later than is optimal. This study was, however, limited by available evidence and a range of quality of life benefits, cost savings and potential harms could not be quantified. It was also beyond the scope of this study to consider dynamic factors such as repeat screening, mortality, disease trajectories or trends in the numbers of people with dementia. A larger study would be needed for this, involving more complex and innovative approaches to generating estimates for modelling. We did not compare population screening for people aged 75 years to other methods for increasing diagnosis rates."," Int J Geriatr Psychiatry. 2015 May;30(5):446-52. ","UK",2015,"Any dementia","Diagnosis",null,null,null,"Unclear",null,"UK",null,"Any dementia","Diagnosis","Unclear",null,null,"2015:2017"]
[54,"Davis JC, Bryan S, Marra CA, Hsiung GY, Liu-Ambrose T. Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia. Br J Sports Med. 2015 Oct;49(20):1343-7. ","doi: 10.1136/bjsports-2013-092743.","Davis JC, Bryan S, Marra CA, Hsiung GY, Liu-Ambrose T."," Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia.","Cognitive decline is one of the most prominent healthcare issues of the 21st century. Within the context of combating cognitive decline through behavioural interventions, physical activity is a promising approach. There is a dearth of health economic data in the area of behavioural interventions for dementia prevention. Yet, economic evaluations are essential for providing information to policy makers for resource allocation. It is essential we first address population and intervention-specific methodological challenges prior to building a larger evidence base. We use a cost-utility analysis conducted alongside the exercise for cognition and everyday living (EXCEL) study to illustrate methodological challenges specific to assessing the cost-effectiveness of behavioural interventions aimed at older adults at risk of cognitive decline. A cost-utility analysis conducted concurrently with a 6-month, three-arm randomised controlled trial (ie, the EXCEL study) was used as an example to identify and discuss methodological challenges. Both the aerobic training and resistance training interventions were less costly than twice weekly balance and tone classes. In critically evaluating the economic evaluation of the EXCEL study we identified four category-specific challenges: (1) analysing costs; (2) assessing quality-adjusted life-years; (3) Incomplete data; and (4) 'Intervention' activities of the control group. Resistance training and aerobic training resulted in healthcare cost saving and were equally effective to balance and tone classes after only 6 months of intervention. To ensure this population is treated fairly in terms of claims on resources, we first need to identify areas for methodological improvement."," Br J Sports Med. 2015 Oct;49(20):1343-7. ","Canada",2015,"Any dementia","Behavioural therapies,Prevention",null,null,null,"Cost-utility",null,"Canada",null,"Any dementia","Behavioural therapies,Prevention","Cost-utility",null,null,"2015:2017"]
[55,"Leroi I, Woolham J, Gathercole R, Howard R, Dunk B, Fox C, O'Brien J, Bateman A, Poland F, Bentham P, Burns A, Davies A, Forsyth K, Gray R, Knapp M, Newman S, McShane R, Ritchie C. Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial. Trials. 2013 Oct 23;14():349. ","doi: 10.1186/1745-6215-14-349. ","Leroi I, Woolham J, Gathercole R, Howard R, Dunk B, Fox C, O'Brien J, Bateman A, Poland F, Bentham P, Burns A, Davies A, Forsyth K, Gray R, Knapp M, Newman S, McShane R, Ritchie C."," Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial.","Assistive technology and telecare (ATT) are relatively new ways of delivering care and support to people with social care needs. It is claimed that ATT reduces the need for community care, prevents unnecessary hospital admission, and delays or prevents admission into residential or nursing care. The current economic situation in England has renewed interest in ATT instead of community care packages. However, at present, the evidence base to support claims about the impact and effectiveness of ATT is limited, despite its potential to mitigate the high financial cost of caring for people with dementia and the social and psychological cost to unpaid carers. ATTILA (Assistive Technology and Telecare to maintain Independent Living At Home for People with Dementia) is a pragmatic, multi-centre, randomised controlled trial over 104 weeks that compares outcomes for people with dementia who receive ATT and those who receive equivalent community services but not ATT. The study hypothesis is that fewer people in the ATT group will go into institutional care over the 4-year period for which the study is funded. The study aims to recruit 500 participants, living in community settings, with dementia or significant cognitive impairment, who have recently been referred to social services.Primary outcome measures are time in days from randomisation to institutionalisation and cost effectiveness. Secondary outcomes are caregiver burden, health-related quality of life in carers, number and severity of serious adverse events, and data on acceptability, applicability and reliability of ATT intervention packages. Assessments will be undertaken in weeks 0 (baseline), 12, 24, 52 and 104 or until institutionalisation or withdrawal of the participant from the trial. In a time of financial austerity, CASSRs in England are increasingly turning to ATT in the belief that it will deliver good outcomes for less money. There is an absence of robust evidence for the cost-effectiveness and benefit of using assistive technology and telecare. The ATTILA trial meets a pressing need for robust, generalisable evidence to either justify continuing investment or reappraise the appropriate scale of ATT use. Current Controlled Trials ISRCTN86537017."," Trials. 2013 Oct 23;14():349. ","UK",2013,"Any dementia","Telecare",null,null,null,"Unclear",null,"UK",null,"Any dementia","Telecare","Unclear",null,null,"2010:2014"]
[56,"Goldfeld KS, Hamel MB, Mitchell SL. The cost-effectiveness of the decision to hospitalize nursing home residents with advanced dementia. J Pain Symptom Manage. 2013 Nov;46(5):640-51. ","doi: 10.1016/j.jpainsymman.2012.11.007.","Goldfeld KS, Hamel MB, Mitchell SL."," The cost-effectiveness of the decision to hospitalize nursing home residents with advanced dementia.","Nursing home (NH) residents with advanced dementia commonly experience burdensome and costly hospitalizations that may not extend survival or improve quality of life. Cost-effectiveness analyses of decisions to hospitalize these residents have not been reported. To estimate the cost-effectiveness of 1) not having a do-not-hospitalize (DNH) order and 2) hospitalization for suspected pneumonia in NH residents with advanced dementia. NH residents from 22 NHs in the Boston area were followed in the Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life study conducted between February 2003 and February 2009. We conducted cost-effectiveness analyses of aggressive treatment strategies for advanced dementia residents living in NHs when they suffer from acute illness. Primary outcome measures included quality-adjusted life days (QALD) and quality-adjusted life years, Medicare expenditures, and incremental net benefits (INBs) over 15 months. Compared with a less aggressive strategy of avoiding hospital transfer (i.e., having DNH orders), the strategy of hospitalization was associated with an incremental increase in Medicare expenditures of $5972 and an incremental gain in quality-adjusted survival of 3.7 QALD. Hospitalization for pneumonia was associated with an incremental increase in Medicare expenditures of $3697 and an incremental reduction in quality-adjusted survival of 9.7 QALD. At a willingness-to-pay level of $100,000/quality-adjusted life years, the INBs of the more aggressive treatment strategies were negative and, therefore, not cost effective (INB for not having a DNH order, -$4958 and INB for hospital transfer for pneumonia, -$6355). Treatment strategies favoring hospitalization for NH residents with advanced dementia are not cost effective."," J Pain Symptom Manage. 2013 Nov;46(5):640-51. ","USA",2013,"Any dementia","Formal care",null,null,null,"Cost-utility",null,"USA",null,"Any dementia","Formal care","Cost-utility",null,null,"2010:2014"]
[57,"Peters JL, Anderson R, Hoyle M, Hyde C. Evolution of a cost-utility model of donepezil for Alzheimer's disease. Int J Technol Assess Health Care. 2013 Apr;29(2):147-54. ","doi: 10.1017/S026646231300007X. ","Peters JL, Anderson R, Hoyle M, Hyde C."," Evolution of a cost-utility model of donepezil for Alzheimer's disease.","The aim of this study was to describe the evolution of a cost-utility model used to inform the UK National Institute for Health and Clinical Excellence's (NICE) most recent decisions on the cost-utility of drug treatments for Alzheimer's disease (AD), and to explore the impact of structural assumptions on the cost-utility results. Changes informed by noted limitations of the decision model used in NICE's previous decisions (in 2006) were made cumulatively to the original decision model for donepezil compared with best supportive care (for patients with mild to moderate AD). Deterministic and probabilistic analyses were undertaken for each cumulative change of the model. The expected value of perfect information (EVPI) of parameter estimates and structural assumptions was also calculated. Cumulative changes to the decision model highlighted how the results of the original model (incremental cost-effectiveness ratio of £81,000 per quality-adjusted life-year gained) related to those of the new model (where donepezil was estimated to be cost-saving), mainly due to uncertainty in the incremental cost of donepezil treatment over best supportive care (ranging from -£600 to £3,000 per patient). The partial EVPI analysis reflected this finding where further information on treatment discontinuations and cost parameter estimates were shown to be valuable in terms of reducing decision uncertainty. Assessing the evolution of the cost-utility model helped to identify and explore structural differences between cohort-based models and is likely to be useful for decision models in other disease areas. This approach makes the structural uncertainty explicit, forcing decision makers to address structural uncertainty in addition to parameter uncertainty."," Int J Technol Assess Health Care. 2013 Apr;29(2):147-54. ","UK",2013,"Alzheimer’s","Donepezil",null,null,null,"Cost-utility",null,"UK",null,"Alzheimer’s","Donepezil","Cost-utility",null,null,"2010:2014"]
[58,"Alves J, Magalhães R, Thomas RE, Gonçalves OF, Petrosyan A, Sampaio A. Is there evidence for cognitive intervention in Alzheimer disease? A systematic review of efficacy, feasibility, and cost-effectiveness. Alzheimer Dis Assoc Disord. 2013 Jul-Sep;27(3):195-203. ","doi: 10.1097/WAD.0b013e31827bda55. ","Alves J, Magalhães R, Thomas RE, Gonçalves OF, Petrosyan A, Sampaio A."," Is there evidence for cognitive intervention in Alzheimer disease? A systematic review of efficacy, feasibility, and cost-effectiveness.","Several studies have shown that cognitive intervention may be beneficial for people with Alzheimer disease (AD), but literature reviews conducted so far, have yielded mixed and inconclusive results. In this work, through an extensive bibliographic search, we aim: (1) to analyze the efficacy of cognitive intervention in patients diagnosed with AD; (2) to provide an estimate of the feasibility of cognitive intervention; and (3) to review available cost-effectiveness data of this approach. Four randomized controlled trials of cognitive intervention, for patients diagnosed with AD that incorporated cognitive intervention and mock intervention control conditions, were included in the analysis. Only the domain of global cognitive functioning, as measured by Mini-Mental State Examination, showed significant intervention effects. No effects were observed in the remaining domains. Concerning feasibility, high rates of completion and adherence were found. A single randomized controlled trial, with unspecified dementia, suggested cognitive intervention to be cost-effective. Given the currently available dearth of well-controlled and focused trials in AD, these results should be carefully interpreted and remain to be confirmed in the future. There is a clear need for more high-quality research."," Alzheimer Dis Assoc Disord. 2013 Jul-Sep;27(3):195-203. ","International",2013,"Alzheimer’s","Cognitive therapies",null,null,null,"Unclear",null,"International",null,"Alzheimer’s","Cognitive therapies","Unclear",null,null,"2010:2014"]
[59,"Blom MM, Bosmans JE, Cuijpers P, Zarit SH, Pot AM. Effectiveness and cost-effectiveness of an internet intervention for family caregivers of people with dementia: design of a randomized controlled trial. BMC Psychiatry. 2013 Jan 10;13():17. ","doi: 10.1186/1471-244X-13-17. ","Blom MM, Bosmans JE, Cuijpers P, Zarit SH, Pot AM."," Effectiveness and cost-effectiveness of an internet intervention for family caregivers of people with dementia: design of a randomized controlled trial.","The number of people with dementia is rising rapidly as a consequence of the greying of the world population. There is an urgent need to develop cost effective approaches that meet the needs of people with dementia and their family caregivers. Depression, feelings of burden and caregiver stress are common and serious health problems in these family caregivers. Different kinds of interventions are developed to prevent or reduce the negative psychological consequences of caregiving. The use of internet interventions is still very limited, although they may be a cost effective way to support family caregivers in an earlier stage and diminish their psychological distress in the short and longer run. A pragmatic randomized controlled trial is designed to evaluate the effectiveness and cost-effectiveness of 'Mastery over Dementia', an internet intervention for caregivers of people with dementia. The intervention aims at prevention and decrease of psychological distress, in particular depressive symptoms. The experimental condition consists of an internet course with 8 sessions and a booster session over a maximum period of 6 months guided by a psychologist. Caregivers in the comparison condition receive a minimal intervention. In addition to a pre and post measurement, an intermediate measurement will be conducted. In addition, there will be two follow-up measurements 3 and 6 months after post-treatment in the experimental group only. To study the effectiveness of the intervention, depressive symptoms are used as the primary outcome, whereas symptoms of anxiety, role overload and caregiver perceived stress are used as secondary outcomes. To study which caregivers profit most of the internet intervention, several variables that may modify the impact of the intervention are taken into account. Regarding the cost-effectiveness, an economic evaluation will be conducted from a societal perspective. This study will provide evidence about the effectiveness and cost-effectiveness of an internet intervention for caregivers. If both can be shown, this might set the stage for the development of a range of internet interventions in the field of caregiving for people with dementia. This is even more important because future generations of caregivers will be more familiar with the use of internet. NTR-2051/RCT-DDB."," BMC Psychiatry. 2013 Jan 10;13():17. ","Netherlands",2013,"Any dementia","Support",null,null,null,"Unclear",null,"Netherlands",null,"Any dementia","Support","Unclear",null,null,"2010:2014"]
[60,"Romeo R, Knapp M, Hellier J, Dewey M, Ballard C, Baldwin R, Bentham P, Burns A, Fox C, Holmes C, Katona C, Lawton C, Lindesay J, Livingston G, McCrae N, Moniz-Cook E, Murray J, Nurock S, O'Brien J, Poppe M, Thomas A, Walwyn R, Wilson K, Banerjee S. Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial. Br J Psychiatry. 2013 Feb;202():121-8. ","doi: 10.1192/bjp.bp.112.115212. ","Romeo R, Knapp M, Hellier J, Dewey M, Ballard C, Baldwin R, Bentham P, Burns A, Fox C, Holmes C, Katona C, Lawton C, Lindesay J, Livingston G, McCrae N, Moniz-Cook E, Murray J, Nurock S, O'Brien J, Poppe M, Thomas A, Walwyn R, Wilson K, Banerjee S."," Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial.","Depression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes. To evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia. A pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0-13 weeks and 0-39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods. There were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively. In terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers."," Br J Psychiatry. 2013 Feb;202():121-8. ","UK",2013,"Any dementia","Antidepressants",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Antidepressants","Cost-utility",null,null,"2010:2014"]
[61,"Djalalov S, Yong J, Beca J, Black S, Saposnik G, Musa Z, Siminovitch K, Moretti M, Hoch JS. Genetic testing in combination with preventive donepezil treatment for patients with amnestic mild cognitive impairment: an exploratory economic evaluation of personalized medicine. Mol Diagn Ther. 2012 Dec;16(6):389-99. ","doi: 10.1007/s40291-012-0010-7. ","Djalalov S, Yong J, Beca J, Black S, Saposnik G, Musa Z, Siminovitch K, Moretti M, Hoch JS."," Genetic testing in combination with preventive donepezil treatment for patients with amnestic mild cognitive impairment: an exploratory economic evaluation of personalized medicine.","To evaluate the cost effectiveness of genetic screening for the apolipoprotein (APOE) ε4 allele in combination with preventive donepezil treatment in comparison with the standard of care for amnestic mild cognitive impairment (AMCI) patients in Canada. We performed a cost-effectiveness analysis using a Markov model with a societal perspective and a time horizon of 30 years. For each strategy, we calculated quality-adjusted life-years (QALYs), using utilities from the literature. Costs were also based on the literature and, when appropriate, Ontario sources. One-way and probabilistic sensitivity analyses were performed. Expected value of perfect information (EVPI) analysis was conducted to explore the value of future research. The base case results in our exploratory study suggest that the combination of genetic testing and preventive donepezil treatment resulted in a gain of 0.027 QALYs and an incremental cost of $1,015 (in 2009 Canadian dollars [Can$]), compared with the standard of care. The incremental cost-effectiveness ratio (ICER) for the base case was Can$38,016 per QALY. The ICER was sensitive to the effectiveness of donepezil in slowing the rate of progression to Alzheimer's disease (AD), utility in AMCI patients, and AD and donepezil treatment costs. EVPI analysis showed that additional information on these parameters would be of value. Using presently available clinical evidence, this exploratory study illustrates that genetic testing combined with preventive donepezil treatment for AMCI patients may be economically attractive. Since our results were based on a secondary post hoc analysis, our study alone is insufficient to warrant recommending APOE genotyping in AMCI patients. Future research on the effectiveness of preventive donepezil as a targeted therapy is recommended."," Mol Diagn Ther. 2012 Dec;16(6):389-99. ","Canada",2012,"Any dementia","Diagnosis,Donepezil",null,null,null,"Cost-utility",null,"Canada",null,"Any dementia","Diagnosis,Donepezil","Cost-utility",null,null,"2010:2014"]
[62,"Jones C, Edwards RT, Hounsome B. Health economics research into supporting carers of people with dementia: a systematic review of outcome measures. Health Qual Life Outcomes. 2012 Nov 26;10():142. ","doi: 10.1186/1477-7525-10-142.","Jones C, Edwards RT, Hounsome B."," Health economics research into supporting carers of people with dementia: a systematic review of outcome measures.","Advisory bodies, such as the National Institute for Health and Clinical Excellence (NICE) in the UK, advocate using preference based instruments to measure the quality of life (QoL) component of the quality-adjusted life year (QALY). Cost per QALY is used to determine cost-effectiveness, and hence funding, of interventions. QALYs allow policy makers to compare the effects of different interventions across different patient groups. Generic measures may not be sensitive enough to fully capture the QoL effects for certain populations, such as carers, so there is a need to consider additional outcome measures, which are preference based where possible to enable cost-effectiveness analysis to be undertaken. This paper reviews outcome measures commonly used in health services research and health economics research involving carers of people with dementia. An electronic database search was conducted in PubMed, Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the National Health Service Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment database. Studies were eligible for inclusion if they included an outcome measure for carers of people with dementia. 2262 articles were identified. 455 articles describing 361 studies remained after exclusion criteria were applied. 228 outcome measures were extracted from the studies. Measures were categorised into 44 burden measures, 43 mastery measures, 61 mood measures, 32 QoL measures, 27 social support and relationships measures and 21 staff competency and morale measures. The choice of instrument has implications on funding decisions; therefore, researchers need to choose appropriate instruments for the population being measured and the type of intervention undertaken. If an instrument is not sensitive enough to detect changes in certain populations, the effect of an intervention may be underestimated, and hence interventions which may appear to be beneficial to participants are not deemed cost-effective and are not funded. If this is the case, it is essential that additional outcome measures which detect changes in broader QoL are included, whilst still retaining preference based utility measures such as EQ-5D to allow QALY calculation for comparability with other interventions."," Health Qual Life Outcomes. 2012 Nov 26;10():142. ","International",2012,"Any dementia","Support",null,null,null,"Cost-utility",null,"International",null,"Any dementia","Support","Cost-utility",null,null,"2010:2014"]
[63,"Pfeil AM, Kressig RW, Szucs TD. Alzheimer's dementia: budget impact and cost-utility analysis of a combination treatment of a cholinesterase inhibitor and memantine in Switzerland. Swiss Med Wkly. 2012 Nov 21;142():w13676. ","doi: 10.4414/smw.2012.13676.","Pfeil AM, Kressig RW, Szucs TD."," Alzheimer's dementia: budget impact and cost-utility analysis of a combination treatment of a cholinesterase inhibitor and memantine in Switzerland.","The objective of this study was to estimate the potential budget impact and cost-effectiveness of the combination treatment of a cholinesterase inhibitor and memantine in Switzerland. The prevalence of dementia according to European sources and future Swiss population data were used to estimate the number of patients with Alzheimer's dementia in Switzerland. Both direct and indirect costs calculated from Swiss sources were included. Utility estimates and transition probabilities were obtained from the published literature. A Markov model was used for the cost-utility analysis in order to calculate incremental cost-effectiveness ratios from a health care and a societal perspective. Assuming mono treatment (either a cholinesterase inhibitor or memantine), treatment costs would increase from CHF 22.7 million in 2012 to CHF 26.1 million in 2016, the additional yearly treatment costs for the combination treatment (cholinesterase inhibitor and memantine) would be between CHF 1.7 million and CHF 1.9 million. The Markov model compared health care costs of the mono treatment to costs of the combination treatment over five years. From a health care perspective, the combination treatment saved CHF 27,655 per patient over five years and CHF 248,895/quality adjusted life year compared to the mono treatment. Implementation of the reimbursed combination treatment would incur additional treatment costs of about CHF 10 million over five years. From a health care perspective, the combination treatment would decrease costs over five years by CHF 50 million. Based on long term considerations, the combination treatment was the dominant strategy over the mono treatment."," Swiss Med Wkly. 2012 Nov 21;142():w13676. ","Switzerland",2012,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility",null,"Switzerland",null,"Alzheimer’s","Any anticholinesterase,Memantine","Cost-utility",null,null,"2010:2014"]
[64,"Hyde C, Peters J, Bond M, Rogers G, Hoyle M, Anderson R, Jeffreys M, Davis S, Thokala P, Moxham T. Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer's disease: systematic review and economic model. Age Ageing. 2013 Jan;42(1):14-20. ","doi: 10.1093/ageing/afs165. ","Hyde C, Peters J, Bond M, Rogers G, Hoyle M, Anderson R, Jeffreys M, Davis S, Thokala P, Moxham T."," Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer's disease: systematic review and economic model.","In 2007 the National Institute of Health and Clinical Excellence (NICE) restricted the use of acetylcholinesterase inhibitors and memantine. we conducted a health technology assessment (HTA) of the effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of AD to re-consider and up-date the evidence base used to inform the 2007 NICE decision. The systematic review of effectiveness targeted randomised controlled trials. A comprehensive search, including MEDLINE, Embase and the Cochrane Library, was conducted from January 2004 to March 2010. All key review steps were done by two reviewers. Random effects meta-analysis was conducted. The cost-effectiveness was assessed using a cohort-based model with three health states: pre-institutionalised, institutionalised and dead. The perspective was NHS and Personal Social Services and the cost year 2009. confidence about the size and statistical significance of the estimates of effect of galantamine, rivastigmine and memantine improved on function and global impact in particular. Cost-effectiveness also changed. For donepezil, galantamine and rivastigmine, the incremental cost per quality-adjusted life year (QALY) in 2004 was above £50,000; in 2010 the same drugs 'dominated' best supportive care (improved clinical outcome at reduced cost). This was primarily because of changes in the modelled costs of introducing the drugs. For memantine, the cost-effectiveness also improved from a range of £37-53,000 per QALY gained to a base-case of £32,000. there has been a change in the evidence base between 2004 and 2010 consistent with the change in NICE guidance. Further evolution in cost-effectiveness estimates is possible particularly if there are changes in drug prices."," Age Ageing. 2013 Jan;42(1):14-20. ","UK",2013,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine",null,null,null,"Cost-utility",null,"UK",null,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine","Cost-utility",null,null,"2010:2014"]
[65,"Sköldunger A, Johnell K, Winblad B, Wimo A. Mortality and treatment costs have a great impact on the cost-effectiveness of disease modifying treatment in Alzheimer's disease--a simulation study. Curr Alzheimer Res. 2013 Feb;10(2):207-16.",null,"Sköldunger A, Johnell K, Winblad B, Wimo A."," Mortality and treatment costs have a great impact on the cost-effectiveness of disease modifying treatment in Alzheimer's disease--a simulation study.","The societal costs of Alzheimer's Disease (AD) are enormous and pose a great challenge for the health and social care in any society. It is of vital importance to develop and identify cost effective treatment. The aim of the study was to present a hypothetical economic model of Disease Modifying Treatment (DMT) in AD. A 20 year Markov cohort model of DMT was constructed, based on Swedish care conditions. States and progression were defined according to the Mini Mental State Examination (MMSE). Epidemiological studies of incidence of dementia, prevalence and costs of Mild Cognitive Impairment (MCI) and AD as well as conversion studies of MCI and demographic statistics were used as inputs in the model. Total costs were 113,797 million SEK for patients treated with DMT vs 88,562 million SEK for untreated patients. The corresponding gained QALYs were 529,945 and 450,307 respectively, giving an incremental cost effectiveness ratio of 293,002 SEK/QALY in the base option. Survival in the model was 8.72 years with DMT and 7.77 years for untreated. With an assumed Willingness to pay (WTP) of 600,000 SEK (about 86,200 US$ and 62,000 ) per gained QALY, the model indicated cost effectiveness with DMT. The sensitivity analysis implied no cost savings with DMT, but most options indicated cost effectiveness vs. the chosen WTP. The main reasons for the higher costs with DMT were the costs of DMT itself and the prolonged survival with DMT. Even if costs increase with DMT, the model indicates cost effectiveness."," Curr Alzheimer Res. 2013 Feb;10(2):207-16.","Sweden",2013,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility",null,"Sweden",null,"Alzheimer’s","Any anticholinesterase,Memantine","Cost-utility",null,null,"2010:2014"]
[66,"Orrell M, Yates LA, Burns A, Russell I, Woods RT, Hoare Z, Moniz-Cook E, Henderson C, Knapp M, Spector A, Orgeta V. Individual Cognitive Stimulation Therapy for dementia (iCST): study protocol for a randomized controlled trial. Trials. 2012 Sep 22;13():172. ","doi: 10.1186/1745-6215-13-172.","Orrell M, Yates LA, Burns A, Russell I, Woods RT, Hoare Z, Moniz-Cook E, Henderson C, Knapp M, Spector A, Orgeta V."," Individual Cognitive Stimulation Therapy for dementia (iCST): study protocol for a randomized controlled trial.","Improving the quality of care for people with dementia and their carers has become a national priority in many countries. Cognitive Stimulation Therapy (CST) groups can be beneficial in improving cognition and quality of life for people with dementia. The aim of the current study is to develop and evaluate a home-based individual Cognitive Stimulation Therapy (iCST) programme for people with dementia which can be delivered by their family carer. This multi-centre, pragmatic randomised controlled trial (RCT) will compare the effectiveness and cost-effectiveness of iCST for people with dementia with a treatment as usual control group. The intervention consists of iCST sessions delivered by a carer for 30 minutes, 3 times a week over 25 weeks.For people with dementia the primary outcome measures are cognition assessed by the ADAS-Cog, and quality of life assessed by QoL-AD. For carers, quality of life using the SF-12 is the primary outcome measure. Using a 5% significance level, comparison of 306 participants will yield 80% power to detect an effect size of 0.35 for cognition as measured by the ADAS-Cog, and quality of life as measured by the QoL-AD. Quality of life for the carer will be measured using the SF-12. The trial will include a cost-effectiveness analysis from a public sector perspective. The UK Department of Health has recently stressed that improving access to psychological therapies is a national priority, but many people with dementia are unable to access psychological interventions. The development of a home-based individual version of CST will provide an easy to use, widely available therapy package that will be evaluated for effectiveness and cost-effectiveness in a multi centre RCT."," Trials. 2012 Sep 22;13():172. ","UK",2012,"Any dementia","Cognitive therapies",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Cognitive therapies","Cost-utility",null,null,"2010:2014"]
[67,"Escudero J, Ifeachor E, Zajicek JP, Green C, Shearer J, Pearson S, Alzheimer's Disease Neuroimaging Initiative. Machine learning-based method for personalized and cost-effective detection of Alzheimer's disease. IEEE Trans Biomed Eng. 2013 Jan;60(1):164-8. ","doi: 10.1109/TBME.2012.2212278. ","Escudero J, Ifeachor E, Zajicek JP, Green C, Shearer J, Pearson S, Alzheimer's Disease Neuroimaging Initiative."," Machine learning-based method for personalized and cost-effective detection of Alzheimer's disease.","Diagnosis of Alzheimer's disease (AD) is often difficult, especially early in the disease process at the stage of mild cognitive impairment (MCI). Yet, it is at this stage that treatment is most likely to be effective, so there would be great advantages in improving the diagnosis process. We describe and test a machine learning approach for personalized and cost-effective diagnosis of AD. It uses locally weighted learning to tailor a classifier model to each patient and computes the sequence of biomarkers most informative or cost-effective to diagnose patients. Using ADNI data, we classified AD versus controls and MCI patients who progressed to AD within a year, against those who did not. The approach performed similarly to considering all data at once, while significantly reducing the number (and cost) of the biomarkers needed to achieve a confident diagnosis for each patient. Thus, it may contribute to a personalized and effective detection of AD, and may prove useful in clinical settings."," IEEE Trans Biomed Eng. 2013 Jan;60(1):164-8. ","UK",2013,"Alzheimer’s","Diagnosis",null,null,null,"Unclear",null,"UK",null,"Alzheimer’s","Diagnosis","Unclear",null,null,"2010:2014"]
[68,"Knapp M, Iemmi V, Romeo R. Dementia care costs and outcomes: a systematic review. Int J Geriatr Psychiatry. 2013 Jun;28(6):551-61. ","doi: 10.1002/gps.3864.","Knapp M, Iemmi V, Romeo R."," Dementia care costs and outcomes: a systematic review.","We reviewed evidence on the cost-effectiveness of prevention, care and treatment strategies in relation to dementia. We performed a systematic review of available literature on economic evaluations of dementia care, searching key databases and websites in medicine, social care and economics. Literature reviews were privileged, and other study designs were included only to fill gaps in the evidence base. Narrative analysis was used to synthesise the results. We identified 56 literature reviews and 29 single studies offering economic evidence on dementia care. There is more cost-effectiveness evidence on pharmacological therapies than other interventions. Acetylcholinesterase inhibitors for mild-to-moderate disease and memantine for moderate-to-severe disease were found to be cost-effective. Regarding non-pharmacological treatments, cognitive stimulation therapy, tailored activity programme and occupational therapy were found to be more cost-effective than usual care. There was some evidence to suggest that respite care in day settings and psychosocial interventions for carers could be cost-effective. Coordinated care management and personal budgets held by carers have also demonstrated cost-effectiveness in some studies. Five barriers to achieving better value for money in dementia care were identified: the scarcity and low methodological quality of available studies, the difficulty of generalising from available evidence, the narrowness of cost measures, a reluctance to implement evidence and the poor coordination of health and social care provision and financing."," Int J Geriatr Psychiatry. 2013 Jun;28(6):551-61. ","International",2013,"Any dementia","Cognitive therapies,Other psychological therapies,Disease management,Any anticholinesterase,Memantine",null,null,null,"Unclear",null,"International",null,"Any dementia","Cognitive therapies,Other psychological therapies,Disease management,Any anticholinesterase,Memantine","Unclear",null,null,"2010:2014"]
[69,"Bond M, Rogers G, Peters J, Anderson R, Hoyle M, Miners A, Moxham T, Davis S, Thokala P, Wailoo A, Jeffreys M, Hyde C. The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of Technology Appraisal No. 111): a systematic review and economic model. Health Technol Assess. 2012;16(21):1-470. ","doi: 10.3310/hta16210.","Bond M, Rogers G, Peters J, Anderson R, Hoyle M, Miners A, Moxham T, Davis S, Thokala P, Wailoo A, Jeffreys M, Hyde C."," The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of Technology Appraisal No.","Alzheimer’s disease (AD) is the most commonly occurring form of dementia. It is predominantly a disease of later life, affecting 5% of those over 65 in the UK. Review and update guidance to the NHS in England and Wales on the clinical effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine [acetylcholinesterase inhibitors (AChEIs)] and memantine within their licensed indications for the treatment of AD, which was issued in November 2006 (amended September 2007 and August 2009). Electronic databases were searched for systematic reviews and/or metaanalyses, randomised controlled trials (RCTs) and ongoing research in November 2009 and updated in March 2010; this updated search revealed no new includable studies. The databases searched included The Cochrane Library (2009 Issue 4, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials), MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, PsycINFO, EconLit, ISI Web of Science Databases--Science Citation Index, Conference Proceedings Citation Index, and BIOSIS; the Centre for Reviews and Dissemination (CRD) databases--NHS Economic Evaluation Database, Health Technology Assessment, and Database of Abstracts of Reviews of Effects. The clinical effectiveness systematic review was undertaken following the principles published by the NHS CRD. We included RCTs whose population was people with AD. The intervention and comparators depended on disease severity, measured by the Mini Mental State Examination (MMSE). mild AD (MMSE 21-26)--donepezil, galantamine and rivastigmine; moderate AD (MMSE 10-20)--donepezil, galantamine, rivastigmine and memantine; severe AD (MMSE < 10)--memantine. Comparators: mild AD (MMSE 21-26)--placebo or best supportive care (BSC); moderate AD (MMSE 10-20)--donepezil, galantamine, rivastigmine, memantine, placebo or BSC; severe AD (MMSE < 10)--placebo or BSC. The outcomes were clinical, global, functional, behavioural, quality of life, adverse events, costs and cost-effectiveness. Where appropriate, data were pooled using pair-wise meta-analysis, multiple outcome measures, metaregression and mixedtreatment comparisons. The decision model was based broadly on the structure of the three-state Markov model described in the previous technology assessment report, based upon time to institutionalisation, parameterised with updated estimates of effectiveness, costs and utilities. Notwithstanding the uncertainty of our results, we found in the base case that the AChEIs are probably cost saving at a willingness-to-pay (WTP) of £’30,000 per qualityadjusted life-year (QALY) for people with mild-to-moderate AD. For this class of drugs, there is a > 99% probability that the AChEIs are more cost-effective than BSC. These analyses assume that the AChEIs have no effect on survival. For the AChEIs, in people with mild to moderate AD, the probabilistic sensitivity analyses suggested that donepezil is the most cost-effective, with a 28% probability of being the most cost-effective option at a WTP of £’30,000 per QALY (27% at a WTP of £’20,000 per QALY). In the deterministic results, donepezil dominates the other drugs and BSC, which, along with rivastigmine patches, are associated with greater costs and fewer QALYs. Thus, although galantamine has a slightly cheaper total cost than donepezil (£’69,592 vs £’69,624), the slightly greater QALY gains from donepezil (1.616 vs 1.617) are enough for donepezil to dominate galantamine.The probability that memantine is cost-effective in a moderate to severe cohort compared with BSC at a WTP of £’30,000 per QALY is 38% (and 28% at a WTP of £’20,000 per QALY). The deterministic ICER for memantine is £’32,100 per/QALY and the probabilistic ICER is £’36,700 per/QALY. Trials were of 6 months maximum follow-up, lacked reporting of key outcomes, provided no subgroup analyses and used insensitive measures. Searches were limited to English language, The model does not include behavioural symptoms and there is uncertainty about the model structure and parameters. The additional clinical effectiveness evidence identified continues to suggest clinical benefit from the AChEIs in alleviating AD symptoms, although there is debate about the magnitude of the effect. Although there is also new evidence on the effectiveness of memantine, it remains less supportive of this drug’s use than the evidence for AChEIs. The conclusions concerning cost-effectiveness are quite different from the previous assessment. This is because both the changes in effectiveness and costs between drug use and non-drug use underlying the ICERs are very small. This leads to highly uncertain results, which are very sensitive to change. RESEARCH PRIORITIES: RCTs to include mortality, time to institutionalisation and quality of life, powered for subgroup analysis. The National Institute for Health Research Health Technology Assessment programme."," 111): a systematic review and economic model. Health Technol Assess. 2012;16(21):1-470. ","UK",2012,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine",null,null,null,"Cost-utility",null,"UK",null,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine","Cost-utility",null,null,"2010:2014"]
[70,"Biasutti M, Dufour N, Ferroud C, Dab W, Temime L. Cost-effectiveness of magnetic resonance imaging with a new contrast agent for the early diagnosis of Alzheimer's disease. PLoS One. 2012;7(4):e35559. ","doi: 10.1371/journal.pone.0035559","Biasutti M, Dufour N, Ferroud C, Dab W, Temime L."," Cost-effectiveness of magnetic resonance imaging with a new contrast agent for the early diagnosis of Alzheimer's disease.","Used as contrast agents for brain magnetic resonance imaging (MRI), markers for beta-amyloid deposits might allow early diagnosis of Alzheimer's disease (AD). We evaluated the cost-effectiveness of such a diagnostic test, MRI+CLP (contrastophore-linker-pharmacophore), should it become clinically available. We compared the cost-effectiveness of MRI+CLP to that of standard diagnosis using currently available cognition tests and of standard MRI, and investigated the impact of a hypothetical treatment efficient in early AD. The primary analysis was based on the current French context for 70-year-old patients with Mild Cognitive Impairment (MCI). In alternative \"screen and treat\" scenarios, we analyzed the consequences of systematic screenings of over-60 individuals (either population-wide or restricted to the ApoE4 genotype population). We used a Markov model of AD progression; model parameters, as well as incurred costs and quality-of-life weights in France were taken from the literature. We performed univariate and probabilistic multivariate sensitivity analyses. The base-case preferred strategy was the standard MRI diagnosis strategy. In the primary analysis however, MRI+CLP could become the preferred strategy under a wide array of scenarios involving lower cost and/or higher sensitivity or specificity. By contrast, in the \"screen and treat\" analyses, the probability of MRI+CLP becoming the preferred strategy remained lower than 5%. It is thought that anti-beta-amyloid compounds might halt the development of dementia in early stage patients. This study suggests that, even should such treatments become available, systematically screening the over-60 population for AD would only become cost-effective with highly specific tests able to diagnose early stages of the disease. However, offering a new diagnostic test based on beta-amyloid markers to elderly patients with MCI might prove cost-effective."," PLoS One. 2012;7(4):e35559. ","France",2012,"Alzheimer’s","Diagnosis",null,null,null,"Cost-utility",null,"France",null,"Alzheimer’s","Diagnosis","Cost-utility",null,null,"2010:2014"]
[71,"Pouryamout L, Dams J, Wasem J, Dodel R, Neumann A. Economic evaluation of treatment options in patients with Alzheimer's disease: a systematic review of cost-effectiveness analyses. Drugs. 2012 Apr 16;72(6):789-802. ","doi: 10.2165/11631830-000000000-00000.","Pouryamout L, Dams J, Wasem J, Dodel R, Neumann A."," Economic evaluation of treatment options in patients with Alzheimer's disease: a systematic review of cost-effectiveness analyses.","Alzheimer's disease (AD) is common among the elderly; it is responsible for 60-80% of all dementia cases. AD is characterized by cognitive decline, behavioural and psychological symptoms, and reductions in functioning and independence. Because of its progressive neurodegenerative nature and unknown aetiology, the burden of AD becomes increasingly significant in an aging population. Estimates indicate that 35.6 million people worldwide suffered from AD in 2010. By 2030 and 2050, this figure is predicted to increase to 65.7 million and 115.4 million, respectively. Costs will also rise along with the increase in the number of people diagnosed with AD. In 2010, the worldwide costs associated with dementia were estimated to be $US604 billion. The objective of this study was to conduct a systematic review of current publications dealing with the pharmacoeconomic factors associated with AD medications and to describe the decision-analytic models used to evaluate long-term outcomes. A systematic literature search was performed to identify articles published between 1 January 2007 and 15 July 2010. The search was also based on a previous systematic review, which included literature up to 2007. Articles were included if they were complete and original economic evaluations of AD and if they were comparative in nature. A quality assessment of the included publications was conducted and relevant information was extracted into tables. Seven out of 2067 identified articles were included in this systematic review. Four articles evaluated treatment with donepezil, one with galantamine and two with memantine. The studies were conducted in America, Europe and Asia. Five different groups of medications were compared. The incremental cost-effectiveness ratios (ICERs) for the group of patients treated with donepezil versus no drug treatment ranged from a dominant value to 281, 416.13 euros per quality-adjusted life-year (QALY). Patients treated with donepezil versus placebo showed ICERs with a range from a dominant value (not specified) up to 20, 866.77 euros per QALY. Treatment with memantine in addition to donepezil versus treatment with donepezil alone showed an ICER range from a dominant value to 6818.33 euros per QALY. In comparison with the memantine treatment as an add-on therapy, the ICER of memantine monotherapy versus standard care (without cholinesterase inhibitors [CEIs]) ranged from a dominant value to 63, 087.20 euros per QALY. Finally, the economic evaluation of galantamine in comparison with usual care without any AD drugs showed ICERs ranging from 1894.70 euros to 6953 euros per QALY. The seven identified publications included in this review indicate that treatment with CEIs or memantine seems to be reasonable in terms of clinical effects and costs for patients with AD. Depending on different hypotheses, assumptions and variables (e.g. time horizon, discount rates, initial number of patients in different states, etc.) in the sensitivity analyses, treatment with these drugs seems to be primarily a cost-effective strategy or even a cost-saving strategy. Nevertheless, the results generally are associated with a degree of uncertainty. The comparability of the results from the different economic evaluations is limited because of the different assumptions made."," Drugs. 2012 Apr 16;72(6):789-802. ","International",2012,"Alzheimer’s","Donepezil,Galantamine,Memantine",null,null,null,"Cost-utility",null,"International",null,"Alzheimer’s","Donepezil,Galantamine,Memantine","Cost-utility",null,null,"2010:2014"]
[72,"Hartz S, Getsios D, Tao S, Blume S, Maclaine G. Evaluating the cost effectiveness of donepezil in the treatment of Alzheimer's disease in Germany using discrete event simulation. BMC Neurol. 2012 Feb 8;12():2. ","doi: 10.1186/1471-2377-12-2. ","Hartz S, Getsios D, Tao S, Blume S, Maclaine G."," Evaluating the cost effectiveness of donepezil in the treatment of Alzheimer's disease in Germany using discrete event simulation.","Previous cost-effectiveness studies of cholinesterase inhibitors have modeled Alzheimer's disease (AD) progression and treatment effects through single or global severity measures, or progression to \"Full Time Care\". This analysis evaluates the cost-effectiveness of donepezil versus memantine or no treatment in Germany by considering correlated changes in cognition, behavior and function. Rates of change were modeled using trial and registry-based patient level data. A discrete event simulation projected outcomes for three identical patient groups: donepezil 10 mg, memantine 20 mg and no therapy. Patient mix, mortality and costs were developed using Germany-specific sources. Treatment of patients with mild to moderately severe AD with donepezil compared to no treatment was associated with 0.13 QALYs gained per patient, and 0.01 QALYs gained per caregiver and resulted in average savings of €7,007 and €9,893 per patient from the healthcare system and societal perspectives, respectively. In patients with moderate to moderately-severe AD, donepezil compared to memantine resulted in QALY gains averaging 0.01 per patient, and savings averaging €1,960 and €2,825 from the healthcare system and societal perspective, respectively.In probabilistic sensitivity analyses, donepezil dominated no treatment in most replications and memantine in over 70% of the replications. Donepezil leads to savings in 95% of replications versus memantine. Donepezil is highly cost-effective in patients with AD in Germany, leading to improvements in health outcomes and substantial savings compared to no treatment. This holds across a variety of sensitivity analyses."," BMC Neurol. 2012 Feb 8;12():2. ","Germany",2012,"Alzheimer’s","Donepezil,Memantine",null,null,null,"Cost-utility",null,"Germany",null,"Alzheimer’s","Donepezil,Memantine","Cost-utility",null,null,"2010:2014"]
[73,"van de Ven G, Draskovic I, Adang EM, Donders RA, Post A, Zuidema SU, Koopmans RT, Vernooij-Dassen MJ. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial. BMC Geriatr. 2012 Jan 3;12():1. ","doi: 10.1186/1471-2318-12-1.","van de Ven G, Draskovic I, Adang EM, Donders RA, Post A, Zuidema SU, Koopmans RT, Vernooij-Dassen MJ."," Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial.","The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursing-home dementia care. The study is a cluster-randomised controlled trial, with nursing homes grouped in clusters. Studywise minimisation is the allocation method. Nursing homes in the intervention group will receive a dementia-care-mapping intervention, while the control group will receive usual care. The primary outcome measure is resident agitation, to be assessed with the Cohen-Mansfield Agitation Inventory. The secondary outcomes are resident neuropsychiatric symptoms, assessed with the Neuropsychiatric Inventory--Nursing Homes and quality of life, assessed with Qualidem and the EQ-5D. The staff outcomes are stress reactions, job satisfaction and job-stress-related absenteeism, and staff turnover rate, assessed with the Questionnaire about Experience and Assessment of Work, the General Health Questionnaire-12, and the Maastricht Job Satisfaction Scale for Health Care, respectively. We will collect the data from the questionnaires and electronic registration systems. We will employ linear mixed-effect models and cost-effectiveness analyses to evaluate the outcomes. We will use structural equation modelling in the secondary analysis to evaluate the plausibility of a theoretical model regarding the effectiveness of the dementia-care mapping intervention. We will set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementia-care mapping broadly. A novelty of dementia-care mapping is that it offers an integral person-centred approach to dementia care in nursing homes. The major strengths of the study design are the large sample size, the cluster-randomisation, and the one-year follow-up. The generalisability of the implementation strategies may be questionable because the motivation for person-centred care in both the intervention and control nursing homes is above average. The results of this study may be useful in improving the quality of care and are relevant for policymakers. The trial is registered in the Netherlands National Trial Register: NTR2314."," BMC Geriatr. 2012 Jan 3;12():1. ","Netherlands",2012,"Any dementia","Disease management",null,null,null,"Cost-utility",null,"Netherlands",null,"Any dementia","Disease management","Cost-utility",null,null,"2010:2014"]
[74,"Döpp CM, Graff MJ, Teerenstra S, Adang E, Nijhuis-van der Sanden RW, Olderikkert MG, Vernooij-Dassen MJ. A new combined strategy to implement a community occupational therapy intervention: designing a cluster randomized controlled trial. BMC Geriatr. 2011 Mar 30;11():13. ","doi: 10.1186/1471-2318-11-13. ","Döpp CM, Graff MJ, Teerenstra S, Adang E, Nijhuis-van der Sanden RW, Olderikkert MG, Vernooij-Dassen MJ."," A new combined strategy to implement a community occupational therapy intervention: designing a cluster randomized controlled trial.","Even effective interventions for people with dementia and their caregivers require specific implementation efforts. A pilot study showed that the highly effective community occupational therapy in dementia (COTiD) program was not implemented optimally due to various barriers. To decrease these barriers and make implementation of the program more effective a combined implementation (CI) strategy was developed. In our study we will compare the effectiveness of this CI strategy with the usual educational (ED) strategy. In this cluster randomized, single-blinded, controlled trial, each cluster consists of at least two occupational therapists, a manager, and a physician working at Dutch healthcare organizations that deliver community occupational therapy. Forty-five clusters, stratified by healthcare setting (nursing home, hospital, mental health service), have been allocated randomly to either the intervention group (CI strategy) or the control group (ED strategy). The study population consists of the professionals included in each cluster and community-dwelling people with dementia and their caregivers. The primary outcome measures are the use of community OT, the adherence of OTs to the COTiD program, and the cost effectiveness of implementing the COTiD program in outpatient care. Secondary outcome measures are patient and caregiver outcomes and knowledge of managers, physicians and OTs about the COTiD program. Implementation research is fairly new in the field of occupational therapy, making this a unique study. This study does not only evaluate the effects of the CI-strategy on professionals, but also the effects of professionals' degree of implementation on client and caregiver outcomes. NCT01117285."," BMC Geriatr. 2011 Mar 30;11():13. ","Netherlands",2011,"Any dementia","Occupational therapy",null,null,null,"Unclear",null,"Netherlands",null,"Any dementia","Occupational therapy","Unclear",null,null,"2010:2014"]
[75,"Chenoweth L, King M, Luscombe G, Forbes I, Jeon YH, Parbury JS, Brodaty H, Fleming R, Haas M. Study protocol of a randomised controlled group trial of client and care outcomes in the residential dementia care setting. Worldviews Evid Based Nurs. 2011 Sep;8(3):153-65. ","doi: 10.1111/j.1741-6787.2010.00204.x.","Chenoweth L, King M, Luscombe G, Forbes I, Jeon YH, Parbury JS, Brodaty H, Fleming R, Haas M."," Study protocol of a randomised controlled group trial of client and care outcomes in the residential dementia care setting.","Literature suggests that quality of life (QOL), quality of care (QOC) and Behavioural and Psychological Symptoms of Dementia (BPSD) can be improved by relatively simple and inexpensive person-centred approaches to nursing care practices (PCC) and modifications to physical environment (PCE). Most research on this topic is observational and few randomised controlled trials have included an economic evaluation of PCC and PCE together. The PerCEN study aims to confirm the value of evidence-based nursing by evaluating the efficacy and cost effectiveness of implementing PCC and PCE in residential dementia care services. This article describes the PerCEN study protocol (ANZCTR 12608000095369). The 3-year study commenced in 2009 in 38 eligible government-accredited residential dementia care homes in New South Wales, Australia. Study participants include 605 consented residents over 60 years of age with dementia and 380 consenting permanent direct-care staff. The study employs a factorial, group-randomised, cohort design with stratification to evaluate the main effects of PCC and PCE and their joint effects (PCC + PCE), compared with Usual Care (UC) and Usual Environment (UE) on QOL, QOC and BPSD in dementia. The primary outcomes analysis will use a mixed-model analysis of covariance to determine the effects of PCC and PCE on resident QOL and BPSD, and QOC, adjusting for stratification and other potential confounders. The incremental cost of providing PCE and PCC over UC and UE will be calculated; costs and outcomes will be presented as a cost-consequence analysis and cost-effectiveness ratios will be estimated as a cost per unit change in resident QOL and BPSD. This cluster-randomised trial will rigorously test Kitwood's Social-Psychological Theory of Personhood in Dementia (Kitwood & Bredin 1992). The results will provide timely and solid evidence that can inform policy and nursing practice development in improving the person's QOL and QOC, and reducing BPSD."," Worldviews Evid Based Nurs. 2011 Sep;8(3):153-65. ","Australia",2011,"Any dementia","Disease management",null,null,null,"Cost-effectiveness",null,"Australia",null,"Any dementia","Disease management","Cost-effectiveness",null,null,"2010:2014"]
[76,"Jutkowitz E, Gitlin LN, Pizzi LT. Evaluating willingness-to-pay thresholds for dementia caregiving interventions: application to the tailored activity program. Value Health. 2010 Sep-Oct;13(6):720-5. ","doi: 10.1111/j.1524-4733.2010.00739.x. ","Jutkowitz E, Gitlin LN, Pizzi LT."," Evaluating willingness-to-pay thresholds for dementia caregiving interventions: application to the tailored activity program.","The study aims to apply willingness-to-pay (WTP) values derived from the literature to inform decision-makers of the cost-effectiveness of the Tailored Activity Program (TAP), an intervention proven to reduce caregiver burden. TAP and other caregiver interventions employ an individual perspective and non-quality-adjusted life-year (QALY) outcome measure where the primary objective is to determine caregiver burden from an individual perspective. Therefore, standard cost/QALY thresholds are not appropriate. To identify relevant WTP values, we searched for studies that: 1) were published in the past 5 years and used contingent valuation methodology to identify WTP; 2) assessed WTP for a dementia-related intervention requiring out-of-pocket expenditure; and 3) asked caregivers their WTP for an outcome related to reducing caregiver burden. Three studies were identified utilizing four WTP values. We also assessed potential financial savings that caregivers could achieve from purchasing TAP. To assess the probability of TAP being cost-effective, we built a Monte Carlo simulation to test the four WTP values applied to two TAP outcome measures: reduction in caregiver hours \"on duty;\" and \"doing things.\"   For outcome measure \"on duty,\" WTP varied between $1.06/hour and $4.58/hour. For outcome measure \"doing things,\" WTP varied between $2.21/hour and $9.57/hour. Applying the four identified WTP values from the literature to TAP outcomes resulted in TAP cost-effectiveness varying between 50% and 80% for both outcome measures. When WTP data are not collected prospectively or conventional metrics cannot be applied, retrospectively assessing literature-derived WTP may be acceptable for informing decision-makers of potential cost-effectiveness of a proven program. Application of WTP to TAP shows potential cost-effectiveness that can be expected under the tested WTP scenarios."," Value Health. 2010 Sep-Oct;13(6):720-5. ","USA",2010,"Any dementia","Support",null,null,null,"Cost-utility",null,"USA",null,"Any dementia","Support","Cost-utility",null,null,"2010:2014"]
[77,"Aguirre E, Spector A, Hoe J, Russell IT, Knapp M, Woods RT, Orrell M. Maintenance Cognitive Stimulation Therapy (CST) for dementia: a single-blind, multi-centre, randomized controlled trial of Maintenance CST vs. CST for dementia. Trials. 2010 Apr 28;11():46. ","doi: 10.1186/1745-6215-11-46. ","Aguirre E, Spector A, Hoe J, Russell IT, Knapp M, Woods RT, Orrell M."," Maintenance Cognitive Stimulation Therapy (CST) for dementia: a single-blind, multi-centre, randomized controlled trial of Maintenance CST vs.","Psychological treatments for dementia are widely used in the UK and internationally, but only rarely have they been standardised, adequately evaluated or systematically implemented. There is increasing recognition that psychosocial interventions may have similar levels of effectiveness to medication, and both can be used in combination. Cognitive Stimulation Therapy (CST) is a 7-week cognitive-based approach for dementia that has been shown to be beneficial for cognition and quality of life and is cost-effective, but there is less conclusive evidence for the effects of CST over an extended period. This multi-centre, pragmatic randomised controlled trial (RCT) to assess the effectiveness and cost-effectiveness of Maintenance CST groups for dementia compares a intervention group who receive CST for 7 weeks followed by the Maintenance CST programme once a week for 24 weeks with the control group who receive CST for 7 weeks, followed by treatment as usual for 24 weeks.The primary outcome measures are quality of life of people with dementia assessed by the QoL-AD and cognition assessed by the ADAS-Cog. Secondary outcomes include the person with dementia's mood, behaviour, activities of daily living, ability to communicate and costs; as well as caregiver health-related quality of life. Using a 5% significance level, comparison of 230 participants will yield 80% power to detect a standardised difference of 0.39 on the ADAS-Cog between the groups. The trial includes a cost-effectiveness analysis from a public sector perspective. A pilot study of longer-term Maintenance CST, offering 16 weekly sessions of maintenance following the initial CST programme, previously found a significant improvement in cognitive function (MMSE) for those on the intervention group. The study identified the need for a large-scale, multi-centre RCT to define the potential longer-term benefits of continuing the therapy. This study aims to provide definitive evidence of the potential efficacy of maintenance CST and establish how far the long-term benefits can be compared with antidementia drugs such as cholinesterase inhibitors."," CST for dementia. Trials. 2010 Apr 28;11():46. ","UK",2010,"Any dementia","Cognitive therapies",null,null,null,"Unclear",null,"UK",null,"Any dementia","Cognitive therapies","Unclear",null,null,"2010:2014"]
[78,"Wong CL, Bansback N, Lee PE, Anis AH. Cost-effectiveness: cholinesterase inhibitors and memantine in vascular dementia. Can J Neurol Sci. 2009 Nov;36(6):735-9. ",null,"Wong CL, Bansback N, Lee PE, Anis AH."," Cost-effectiveness: cholinesterase inhibitors and memantine in vascular dementia.","Several randomized controlled trials of cholinesterase inhibitors and memantine in mild to moderate vascular dementia have demonstrated the efficacy of these treatments. However, given these drugs incur considerable cost, the economic argument for their use is less clear. To determine the incremental cost-effectiveness of cholinesterase inhibitors and memantine for mild to moderate vascular dementia. A decision analysis model using a 24-28 week time horizon was developed. Outcomes of cholinesterase inhibitors and memantine and probabilities of adverse events were extracted from a systematic review. Costs of adverse events, medications, and physician visits were obtained from local estimates. Robustness was tested with probabilistic sensitivity analysis using a Monte Carlo simulation. Donepezil 5 mg daily, donepezil 10 mg daily, galantamine 16-24 mg daily, rivastigmine flexible dosing up to 6 mg twice daily, or memantine 10 mg twice daily versus standard care. Incremental cost-effectiveness ratio (ICER) expressed as cost per unit decrease in the Alzheimer's Disease Assessment Scale-cognitive (ADAS-cog) subscale. Donepezil 10 mg daily was found to be the most cost-effective treatment with an ICER of $400.64 (95%CI, $281.10-$596.35) per unit decline in the ADAS-cog subscale. All other treatments were dominated by donepezil 10 mg, that is, more costly and less effective. From a societal perspective, treatment with cholinesterase inhibitors or memantine was more effective but also more costly than standard care for mild to moderate vascular dementia. The donepezil 10 mg strategy was the most cost-effective and also dominated the other alternatives."," Can J Neurol Sci. 2009 Nov;36(6):735-9. ","Canada",2009,"Vascular dementia","Donepezil,Galantamine,Memantine,Rivastigmine",null,null,null,"Cost-effectiveness",null,"Canada",null,"Vascular dementia","Donepezil,Galantamine,Memantine,Rivastigmine","Cost-effectiveness",null,null,"2005:2009"]
[79,"McKeage K. Memantine: a review of its use in moderate to severe Alzheimer's disease. CNS Drugs. 2009 Oct;23(10):881-97. ","doi: 10.2165/11201020-000000000-00000. ","McKeage K."," Memantine: a review of its use in moderate to severe Alzheimer's disease.","Memantine is an uncompetitive, moderate-affinity NMDA receptor antagonist that is indicated for the treatment of moderate to severe Alzheimer's disease. In well designed trials in patients with moderate to severe Alzheimer's disease, oral memantine monotherapy improved outcomes in the area of functional ability more than placebo in one trial, but in a second trial, treatment differences did not reach significance. Memantine has a distinct mode of action compared with that of acetylcholinesterase (AChE) inhibitors, and in a well designed study, combination therapy with memantine plus donepezil improved outcomes more than donepezil plus placebo in all four domains (function, cognition, behaviour and global change). Memantine is generally well tolerated, with adverse events occurring with a similar incidence to that reported with placebo. In modelled cost-effectiveness analyses, memantine was dominant to no therapy in regard to cost per quality-adjusted life-year (QALY) gained, and the combination of memantine plus donepezil was dominant to donepezil therapy alone in regard to QALYs gained when treatment periods exceeded 1 year in patients with moderate to severe disease. Thus, in the management of patients with moderate to severe Alzheimer's disease, memantine provides an effective treatment option. To date, clinical trial support is greater for memantine use in combination with an AChE inhibitor, while more data are needed to confirm its efficacy as monotherapy."," CNS Drugs. 2009 Oct;23(10):881-97. ","International",2009,"Alzheimer’s","Donepezil,Memantine",null,null,null,"Cost-utility",null,"International",null,"Alzheimer’s","Donepezil,Memantine","Cost-utility",null,null,"2005:2009"]
[80,"Woods RT, Bruce E, Edwards RT, Hounsome B, Keady J, Moniz-Cook ED, Orrell M, Russell IT. Reminiscence groups for people with dementia and their family carers: pragmatic eight-centre randomised trial of joint reminiscence and maintenance versus usual treatment: a protocol. Trials. 2009 Jul 30;10():64. ","doi: 10.1186/1745-6215-10-64.","Woods RT, Bruce E, Edwards RT, Hounsome B, Keady J, Moniz-Cook ED, Orrell M, Russell IT."," Reminiscence groups for people with dementia and their family carers: pragmatic eight-centre randomised trial of joint reminiscence and maintenance versus usual treatment: a protocol.","The growing number of people with dementia, and the increasing cost of care, provides a major incentive to develop and test methods of supporting them in the community for longer. Most attention has been given to pharmacological interventions, but there is increasing recognition that psychosocial interventions may be equally effective, even preferable where medication has negative side-effects. Reminiscence groups, run by professionals and volunteers, which use photographs, recordings and other objects to trigger personal memories are probably the most popular therapeutic approach to working with people with dementia, but there is little evidence for their effectiveness and cost-effectiveness. The recent inclusion of family carers in groups with people with dementia, notably in our own pilot studies, has generated informal evidence that this joint approach improves relationships between people with dementia and their carers, and benefits both. This multi-centre, pragmatic randomised controlled trial (RCT) to assess the effectiveness and cost-effectiveness of joint reminiscence groups for people with dementia and their family care-givers has two parallel arms--an intervention group and a control group who receive care as usual. The intervention consists of joint reminiscence groups held weekly for twelve consecutive weeks, followed by monthly maintenance sessions for a further seven months.The primary outcome measures are the quality of life of people with dementia, as assessed by QoL-AD, and their care-givers' mental health as assessed by the GHQ-28. Secondary outcomes include: the autobiographical memories of people with dementia; the quality of the relationship between them and their care-givers; and the levels of depression and anxiety felt by them and their care-giver. Using a 5% significance level, comparison of 200 pairs attending joint reminiscence groups with 200 pairs receiving usual treatment will yield 80% power to detect a standardised difference of 0.38 in the QoL-AD rated by the person with dementia and 0.28 in the GHQ-28 or carer-rated QoL-AD. The trial will include a cost-effectiveness analysis from a public sector perspective. Our Cochrane review (2005) on reminiscence therapy for people with dementia did not identify any rigorous trials or economic analyses in this field. ISRCTN42430123."," Trials. 2009 Jul 30;10():64. ","UK",2009,"Any dementia","Other psychological therapies",null,null,null,"Unclear",null,"UK",null,"Any dementia","Other psychological therapies","Unclear",null,null,"2005:2009"]
[81,"Gustavsson A, Van Der Putt R, Jönsson L, McShane R. Economic evaluation of cholinesterase inhibitor therapy for dementia: comparison of Alzheimer's disease and Dementia with Lewy bodies. Int J Geriatr Psychiatry. 2009 Oct;24(10):1072-8. ","doi: 10.1002/gps.2223. ","Gustavsson A, Van Der Putt R, Jönsson L, McShane R."," Economic evaluation of cholinesterase inhibitor therapy for dementia: comparison of Alzheimer's disease and Dementia with Lewy bodies.","To assess the cost effectiveness of cholinesterase inhibitor (ChEI) treatment in patients with Alzheimer's disease (AD) and Dementia with Lewy bodies (DLB). We used 4-month open label follow-up data from routine memory clinic patients. There were 852 patients with AD and 112 with DLB. We applied three predictive models to estimate clinical and economic outcomes at five years, comparing AD and DLB patients with hypothetical untreated controls. The mean improvement in MMSE in 852 AD patients was 0.57 (SD 3.4) at 4 months, and in the subgroup with baseline MMSE of 10-20 (moderate) was 1.6 (SD 3.7). Overall, the 112 DLB patients improved by 1.4 (SD 3.7). DLB patients with an MMSE 10-20 improved by 3.1 (SD 4.5) points. These efficacy data were input into the SHTAC, microsimulation and Markov models and produced estimated costs per QALY gained (CQG) for all AD of pound194,066, pound67,904 and pound123,935 respectively. In comparison, the CQGs for all DLB were pound46,794, pound2,706 and pound35,922. For the moderate subgroups only the SHTAC and microsimulation models were applicable. These gave CQG estimates for moderate AD of pound39,664 and cost saving respectively. For moderate DLB, both estimates were cost saving. The cost per QALY gained of cholinesterase treatment of all patients with DLB (including those with MMSE outside the 10-20 range) is comparable to that of patients with moderate AD, and is probably cost saving."," Int J Geriatr Psychiatry. 2009 Oct;24(10):1072-8. ","UK",2009,"Alzheimer’s,Lewy body dementia","Any anticholinesterase",null,null,null,"Cost-utility",null,"UK",null,"Alzheimer’s,Lewy body dementia","Any anticholinesterase","Cost-utility",null,null,"2005:2009"]
[82,"Wolfs CA, Dirksen CD, Kessels A, Severens JL, Verhey FR. Economic evaluation of an integrated diagnostic approach for psychogeriatric patients: results of a randomized controlled trial. Arch Gen Psychiatry. 2009 Mar;66(3):313-23. ","doi: 10.1001/archgenpsychiatry.2008.544.","Wolfs CA, Dirksen CD, Kessels A, Severens JL, Verhey FR."," Economic evaluation of an integrated diagnostic approach for psychogeriatric patients: results of a randomized controlled trial.","Because of the increasing number of elderly people with dementia, the costs of dementia and dementia care are expected to grow rapidly in the coming decades. Cost-effectiveness results are relevant for decision making about new strategies in dementia care. To evaluate the cost-effectiveness of an integrated multidisciplinary diagnostic facility for diagnosing dementia in ambulatory psychogeriatric patients. Randomized controlled trial with an economic evaluation component. The Maastricht Evaluation of a Diagnostic Intervention for Cognitively Impaired Elderly, Maastricht University Hospital, Maastricht, the Netherlands. A total of 137 patients who received care in the multidisciplinary diagnostic facility and 93 who received usual care. Quality-adjusted life-years (QALYs) as the main outcome measure and cognition and behavioral problems as secondary outcome measures. Compared with patients receiving usual care, patients who visited the diagnostic facility gained a mean 0.05 QALY at the extra cost of euro65. The incremental cost per QALY amounted to euro1267. This point estimate lies beneath commonly accepted thresholds and is within an acceptable range of uncertainty. With regard to the secondary analyses, cost-effectiveness results showed a substantial amount of uncertainty and were therefore indecisive. On the basis of the main cost-per-QALY analysis, the use of the integrated multidisciplinary diagnostic facility is cost-effective for the diagnosis and management of dementia in ambulatory patients."," Arch Gen Psychiatry. 2009 Mar;66(3):313-23. ","Netherlands",2009,"Any dementia","Diagnosis",null,null,null,"Cost-utility",null,"Netherlands",null,"Any dementia","Diagnosis","Cost-utility",null,null,"2005:2009"]
[83,"López-Bastida J, Hart W, García-Pérez L, Linertová R. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease. J Alzheimers Dis. 2009;16(2):399-407. ","doi: 10.3233/JAD-2009-0965.","López-Bastida J, Hart W, García-Pérez L, Linertová R."," Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease.","Available treatments for Alzheimer's disease (AD) need to be evaluated in order to determine whether the clinical benefits justify their additional costs. This study evaluated the cost-effectiveness of donepezil treatment compared with no-drug treatment of mild and moderate AD from the perspective of society and the health care system in Spain. A Markov model was designed to simulate the natural history of a cohort of patients with mild and moderate AD. Monthly transition probabilities were estimated from the international literature and donepezil clinical trials. Direct medical and non-medical costs and utilities were derived from Spanish studies. Local data on tolerance and medication withdrawal rates were incorporated into the model. Incremental cost-effectiveness ratios for a range of realistic treatment options were calculated. A probabilistic sensitivity analysis was carried out using a Monte Carlo approach with 10,000 iterations. In the baseline scenario (24 months, patients initially with mild AD) incremental cost-effectiveness for direct medical costs was 20,353 euro/QALY. When all costs were taken into account, donepezil treatment was the dominant strategy. Incremental cost-effectiveness ratios vary according to the selected perspective. For the baseline scenario, donepezil treatment is cost-effective with a probability of 95% for a threshold efficiency of 25,000 euro/QALY."," J Alzheimers Dis. 2009;16(2):399-407. ","Spain",2009,"Alzheimer’s","Donepezil",null,null,null,"Cost-utility",null,"Spain",null,"Alzheimer’s","Donepezil","Cost-utility",null,null,"2005:2009"]
[84,"Banerjee S, Wittenberg R. Clinical and cost effectiveness of services for early diagnosis and intervention in dementia. Int J Geriatr Psychiatry. 2009 Jul;24(7):748-54. ","doi: 10.1002/gps.2191.","Banerjee S, Wittenberg R."," Clinical and cost effectiveness of services for early diagnosis and intervention in dementia.","This paper analyses the costs and benefits of commissioning memory services for early diagnosis and intervention for dementia. A model was developed to examine potential public and private savings associated with delayed admissions to care homes in England as a result of the commissioning of memory services. The new services would cost around pound sterling 220 million extra per year nationally in England. The estimated savings if 10% of care home admissions were prevented would by year 10 be around pound sterling 120 million in public expenditure (social care) and pound sterling 125 million in private expenditure (service users and their families), a total of pound sterling 245 million. Under a 20% reduction, the annual cost would within around 6 years be offset by the savings to public funds alone. In 10 years all people with dementia will have had the chance to be seen by the new services. A gain of between 0.01 and 0.02 QALYs per person year would be sufficient to render the service cost-effective (in terms of positive net present value). These relatively small improvements seem very likely to be achievable. These analyses suggest that the service need only achieve a modest increase in average quality of life of people with dementia, plus a 10% diversion of people with dementia from residential care, to be cost-effective. The net increase in public expenditure would then, on the assumptions discussed and from a societal perspective, be justified by the expected benefits. This modelling presents for debate support for the development of nationwide services for the early identification and treatment of dementia in terms of quality of life and overall cost-effectiveness."," Int J Geriatr Psychiatry. 2009 Jul;24(7):748-54. ","UK",2009,"Any dementia","Diagnosis",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Diagnosis","Cost-utility",null,null,"2005:2009"]
[85,"Wilson E, Thalanany M, Shepstone L, Charlesworth G, Poland F, Harvey I, Price D, Reynolds S, Mugford M. Befriending carers of people with dementia: a cost utility analysis. Int J Geriatr Psychiatry. 2009 Jun;24(6):610-23. ","doi: 10.1002/gps.2164.","Wilson E, Thalanany M, Shepstone L, Charlesworth G, Poland F, Harvey I, Price D, Reynolds S, Mugford M."," Befriending carers of people with dementia: a cost utility analysis.","There is very little evidence on the cost-effectiveness of social care interventions for people with dementia or their carers. The BEfriending and Costs of CAring trial (BECCA, ISRCTN08130075) aimed to establish whether a structured befriending service improved the quality of life of carers of people with dementia, and at what cost. We performed an economic evaluation alongside a single blind, randomised controlled trial in a community setting of 236 carers of people with a primary progressive dementia. The intervention was contact with a Befriender Facilitator (BF), and offer of match with a trained lay volunteer befriender compared with no BF contact. Main outcome measures were health and social care, voluntary sector, and family care costs and quality adjusted life years (QALYs) in carers over 15 months. Mean QALYs per carer over 15 months were 0.017 higher in the intervention group compared with control (95%CI: -0.051, 0.083). Mean costs from a societal perspective were pound 1,813 higher (- pound 11,312, pound 14,984). The point estimate Incremental Cost Effectiveness Ratio (ICER) is thus pound 105,954 per incremental QALY gained. Probabilistic sensitivity analysis suggests a 42.2% probability that the ICER is below pound 30,000 per QALY. Inclusion of dementia patient QALYs reduces the ICER to pound 28,848 (51.4% probability below pound 30,000). Befriending leads to a non-significant trend towards improved carer quality of life, and there is a non-significant trend towards higher costs for all sectors. It is unlikely that befriending is a cost-effective intervention from the point of view of society."," Int J Geriatr Psychiatry. 2009 Jun;24(6):610-23. ","UK",2009,"Any dementia","Support",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Support","Cost-utility",null,null,"2005:2009"]
[86,"Soejono CH. The impact of 'comprehensive geriatric assessment (CGA)' implementation on the effectiveness and cost (CEA) of healthcare in an acute geriatric ward. Acta Med Indones. 2008 Jan;40(1):3-10. ",null,"Soejono CH."," The impact of 'comprehensive geriatric assessment (CGA)' implementation on the effectiveness and cost (CEA) of healthcare in an acute geriatric ward.","To investigate the cost effectiveness of CGA in an acute geriatric ward. a non-randomized controlled trial was carried out at Dr. Cipto Mangunkusumo General Hospital from January to December 2005. The inclusion criteria were elderly patients with geriatric syndrome. Exclusion criteria were advanced malignancy, APACHE II score > 34,in-hospital mortality in the first 24 hours, move to another ward before completing CGA management, the presence of dementia. After patients were allocated into CGA and non-CGA group, effectiveness was assessed using ADL/WHO Unescap score, days of hospitalization, proportion of re-hospitalization, survival, quality of life score (EQ5D),patients and nurses satisfaction score. Cost effectiveness analysis was done using TreeAge-Pro 2004 software program. the length of hospitalization was shorter in the CGA group than in non-CGA group (10.99 [0.79] days vs.20.16 [2.62] days; p=0.00). At the end of treatment, mean of ADL score changes was significantly higher in CGA group than non-CGA group. Mean of WHO-Unescap score changes in CGA group was higher than non-CGA group (0.71[0.04]vs 0.61 [0.04]; p=0.09). EQ5D-VAS score was also higher in CGA group (0.79[0,01] vs 0.75[0.01]; p=0,01). Survival proportion in CGA group was lower than non-CGA group(80.37% vs 86.92%; p>0.05). Rehospitalization proportion was higher in non-CGA group than in CGA group (21.5%vs 11.21%; p 0.04). Patient's satisfaction level was higher in CGA group (193.38 [1.25] vs 177.47 [3.04]; p=0.00).Nurse satisfaction level was also higher in CGA group than non-CGA group but not statistically significant (225.06[7.08] vs 220.06[8.26]; p=0.65).Mean of healthcare cost in non-CGA group was higher than in CGA group (Rp. 9,746,426.00 [1,180,331] vs Rp 4,760,965.00 [338,089]). Cost effectiveness analysis indicated that CGA was superior to conventional approach because for each point score of QALD's, total cost was lower in geriatric acute care unit than in conventional ward(Rp 418,199.00 vs Rp 628,695.00). Moreover, QALD's in CGA group was better than in non-CGA group (24.1 vs 22.8; p= 0.03). the CGA approach is more cost effective compared to conventional approach. Quality adjusted life days are better in CGA group than in non-CGA group although survival is not statistically different. In CGA group, length of hospitalization was shorter, functional status and patient satisfaction is better in general. Working satisfaction of nurses in CGA group was not lower than in non CGA group."," Acta Med Indones. 2008 Jan;40(1):3-10. ","Indonesia",2008,"Any dementia","Disease management",null,null,null,"Cost-utility",null,"Indonesia",null,"Any dementia","Disease management","Cost-utility",null,null,"2005:2009"]
[87,"Kirbach S, Simpson K, Nietert PJ, Mintzer J. A markov model of the cost effectiveness of olanzapine treatment for agitation and psychosis in Alzheimer's disease. Clin Drug Investig. 2008;28(5):291-303.",null,"Kirbach S, Simpson K, Nietert PJ, Mintzer J."," A markov model of the cost effectiveness of olanzapine treatment for agitation and psychosis in Alzheimer's disease.","Antipsychotics have long been used to treat agitation and psychosis related to Alzheimer's disease, but in a limited fashion because of troubling adverse effects. The new atypical antipsychotics are thought to be at least as effective as first-generation drugs and to cause fewer adverse effects. These drugs, however, are currently not US FDA-approved for use among elderly demented subjects due to a slight increase in the risk of death and serious cardiovascular events within this population. However, their favourable adverse effect profile has led many physicians to prescribe these drugs as first-line therapy for behaviourally disturbed patients with Alzheimer's disease. Clinical trials to evaluate the use of atypical antipsychotics have produced varying results, and clarity has not yet been achieved. Thus, a quantitative summary of the risks and benefits may help inform complex decisions that must be made in this area. In this study we set out to compare the expected costs and outcomes for a community-dwelling cohort of patients with Alzheimer's disease with agitation and/or psychosis who are (a) untreated, or (b) treated with olanzapine. We constructed a Markov state-transition model using the best published data from several sources for Alzheimer's disease patient progression and treatment. This model allowed us to compare the expected costs and outcomes associated with olanzapine treatment compared with no treatment for a synthetic cohort of US adults aged > or =65 years. The model cycles every 6 months and continues until all patients die from Alzheimer's disease progression or from co-morbid conditions. Outcome estimates included the incremental cost-effectiveness ratio (ICER) and cost per quality-adjusted life-year (QALY) gained. The robustness of the estimates was examined by sensitivity analyses of key parameters, including cost of care, olanzapine effectiveness and Alzheimer's disease progression rates. Results indicated that olanzapine was a cost-effective treatment for agitation and psychosis related to Alzheimer's disease when compared with no treatment (ICER <$US50,000). In addition, sensitivity analyses demonstrated that olanzapine remained cost effective despite multiple variations of several parameters, both alone and concurrently. Olanzapine treatment for agitation and psychosis related to Alzheimer's disease is cost effective when compared with no treatment. Further analysis should be performed as atypical antipsychotics become generic, as more information on health utilities in the Alzheimer's disease population becomes available, and to compare atypical antipsychotics with first-generation antipsychotics."," Clin Drug Investig. 2008;28(5):291-303.","USA",2008,"Alzheimer’s","Antipsychotics",null,null,null,"Cost-utility",null,"USA",null,"Alzheimer’s","Antipsychotics","Cost-utility",null,null,"2005:2009"]
[88,"Charlesworth G, Shepstone L, Wilson E, Thalanany M, Mugford M, Poland F. Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial. Health Technol Assess. 2008 Mar;12(4):iii, v-ix, 1-78.",null,"Charlesworth G, Shepstone L, Wilson E, Thalanany M, Mugford M, Poland F."," Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial.","To determine whether a social support intervention (access to an employed befriending facilitator in addition to usual care) is effective compared with usual care alone. Also to document direct and indirect costs, and establish incremental cost-effectiveness. The Befriending and Costs of Caring (BECCA) trial was a cost-effectiveness randomised controlled trial. Data on well-being and resource use were collected through interviews with participants at baseline and at 6, 15 and 24 months. This research was carried out in the English counties of Norfolk and Suffolk, and the London Borough of Havering. It was a community-based study. Participants were family carers who were cohabiting with, or providing at least 20 hours' care per week for, a community-dwelling relative with a primary progressive dementia. The intervention was 'access to a befriender facilitator' (BF). BFs, based with charitable/voluntary-sector organisations, were responsible for local befriending schemes, including recruitment, screening, training and ongoing support of befriending volunteers, and for matching carers with befrienders. The role of befrienders was to provide emotional support for carers. The target duration for befriending relationships was 6 months or more. Depression was measured by the Hospital Anxiety and Depression Scale (HADS) at 15 months postrandomisation. The health-related quality of life scale EQ-5D (EuroQol 5 Dimensions) was used to derive utilities for the calculation of quality-adjusted life-years (QALYs). A total of 236 carers were randomised into the trial (116 intervention; 120 control). At final follow-up, 190 carers (93 intervention; 97 control) were still involved in the trial (19% attrition). There was no evidence of effectiveness or cost-effectiveness from the primary analyses on the intention-to-treat population. The mean incremental cost per incremental QALY gained was in excess of 100,000 pounds, with only a 42.2% probability of being below 30,000 pounds per QALY gained. Where care-recipient QALYs were included, mean incremental cost per incremental QALY gained was 26,848 pounds, with a 51.4% probability of being below 30,000 pounds per QALY gained. Only 60 carers (52%) took up the offer of being matched with a trained lay befriender, and of these only 37 (32%) were befriended for 6 months or more. A subgroup analysis of controls versus those befriended for 6 months or more found a reduction in HADS-depression scores that approached statistical significance (95% CI -0.09 to 2.84). 'Access to a befriender facilitator' is neither an effective nor a cost-effective intervention in the support of carers of people with dementia, although there is a suggestion of cost-effectiveness for the care dyad (carer and care recipient). In common with many services for carers of people with dementia, uptake of befriending services was not high. However, the small number of carers who engaged with befrienders for 6 months or more reported a reduction in scores on HADS depression that approached statistical significance compared with controls (95% CI -0.09 to 2.84). While providing only weak evidence of any beneficial effect, further research into befriending interventions for carers is warranted."," Health Technol Assess. 2008 Mar;12(4):iii, v-ix, 1-78.","UK",2008,"Any dementia","Support",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Support","Cost-utility",null,null,"2005:2009"]
[89,"Joling KJ, van Hout HP, Scheltens P, Vernooij-Dassen M, van den Berg B, Bosmans J, Gillissen F, Mittelman M, van Marwijk HW. (Cost)-effectiveness of family meetings on indicated prevention of anxiety and depressive symptoms and disorders of primary family caregivers of patients with dementia: design of a randomized controlled trial. BMC Geriatr. 2008 Jan 21;8():2. ","doi: 10.1186/1471-2318-8-2","Joling KJ, van Hout HP, Scheltens P, Vernooij-Dassen M, van den Berg B, Bosmans J, Gillissen F, Mittelman M, van Marwijk HW."," (Cost)-effectiveness of family meetings on indicated prevention of anxiety and depressive symptoms and disorders of primary family caregivers of patients with dementia: design of a randomized controlled trial.","Dementia is a major public health problem with enormous costs to society and major consequences for both patients and their relatives. Family members of persons with dementia provide much of the care for older adults with dementia in the community. Caring for a demented relative is not easy and fraught with emotional strain, distress, and physical exhaustion. Family caregivers of dementia patients have an extremely high risk developing affective disorders such as major depression and anxiety disorder. Family meetings appear to be among the most powerful psychosocial interventions to reduce depression in caregivers. An American landmark study reported substantial beneficial effects of a multifaceted intervention where family meetings had a central place on depression in family caregivers as well as on delay of institutionalization of patients. These effects were not replicated in other countries yet. We perform the first trial comparing only structured family meetings with significant others versus usual care among primary family caregivers of community dwelling demented patients and measure the effectiveness on both depression and anxiety in the primary caregiver, both on disorder and symptom levels. In this randomized controlled trial effectiveness as well as cost-effectiveness of family meetings is evaluated. The intervention group receives four family meetings with family and close friends of the primary family caregiver of a community dwelling patient with a clinical diagnosis of dementia. Dyads of patients and their primary caregiver are followed up to one year after baseline assessment. The main outcome measures are the incidence of anxiety and depressive disorders assessed with the Mini-International Neuropsychiatric Interview (MINI) and the severity of anxiety and depressive symptoms in caregivers is measured by validated self report instruments: the Centre for Epidemiologic Studies Depression Scale (CES-D) for depression and the anxiety scales of the Hospital Anxiety and Depression scales (HADS) for anxiety. The economic evaluation is performed from a societal perspective. By evaluating the effectiveness of only structured family meetings organized in the Netherlands, this study will contribute to the existing literature about the value of psychosocial interventions for dementia caregivers. Dutch Trial Registry ISRCTN90163486."," BMC Geriatr. 2008 Jan 21;8():2. ","Netherlands",2008,"Any dementia","Support",null,null,null,"Unclear",null,"Netherlands",null,"Any dementia","Support","Unclear",null,null,"2005:2009"]
[90,"Nichols LO, Chang C, Lummus A, Burns R, Martindale-Adams J, Graney MJ, Coon DW, Czaja S, Resources for Enhancing Alzheimer's Caregivers Health II Investigators. The cost-effectiveness of a behavior intervention with caregivers of patients with Alzheimer's disease. J Am Geriatr Soc. 2008 Mar;56(3):413-20. ","doi: 10.1111/j.1532-5415.2007.01569.x. ","Nichols LO, Chang C, Lummus A, Burns R, Martindale-Adams J, Graney MJ, Coon DW, Czaja S, Resources for Enhancing Alzheimer's Caregivers Health II Investigators."," The cost-effectiveness of a behavior intervention with caregivers of patients with Alzheimer's disease.","To examine the cost-effectiveness of a randomized, clinical trial of a home-based intervention for caregivers of people with dementia. This cost-effectiveness analysis examined Resources for Enhancing Alzheimer's Caregivers Health (REACH II), a multisite, randomized, clinical trial, from June 2002 through December 2004, funded by the National Institute on Aging and the National Institute of Nursing Research, of a behavioral intervention to decrease caregivers' stress and improve management of care recipient behavioral problems. Community-dwelling dementia caregiving dyads from the Memphis REACH II site. Of Memphis' random sample of 55 intervention and 57 control black and white dyads, 46 in each arm completed without death or discontinuation. Family caregivers were aged 21 and older, lived with the care recipient, and had provided 4 or more hours of care per day for 6 months or longer. Care recipients were cognitively and functionally impaired. Twelve individual sessions (9 home sessions and 3 telephone sessions) supplemented by five telephone support-group sessions. Control caregivers received two \"check in\" phone calls. Incremental cost-effectiveness ratio (ICER), the additional cost to bring about one additional unit of benefit (hours per day of providing care). At 6 months, there was a significant difference between intervention caregivers and control caregivers in hours providing care (P=.01). The ICER showed that intervention caregivers had 1 extra hour per day not spent in caregiving, at a cost of $5 per day. The intervention provided that most scarce of caregiver commodities--time. The emotional and physical costs of dementia caregiving are enormous, and this intervention was able to alleviate some of that cost."," J Am Geriatr Soc. 2008 Mar;56(3):413-20. ","USA",2008,"Alzheimer’s","Support",null,null,null,"Cost-effectiveness",null,"USA",null,"Alzheimer’s","Support","Cost-effectiveness",null,null,"2005:2009"]
[91,"Graff MJ, Adang EM, Vernooij-Dassen MJ, Dekker J, Jönsson L, Thijssen M, Hoefnagels WH, Rikkert MG. Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study. BMJ. 2008 Jan 19;336(7636):134-8. ","doi: 10.1136/bmj.39408.481898.BE. ","Graff MJ, Adang EM, Vernooij-Dassen MJ, Dekker J, Jönsson L, Thijssen M, Hoefnagels WH, Rikkert MG."," Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study.","To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint. Cost effectiveness study alongside a single blind randomised controlled trial. Memory clinic, day clinic of a geriatrics department, and participants' homes. Patients 135 patients aged > or =65 with mild to moderate dementia living in the community and their primary care givers. 10 sessions of occupational therapy over five weeks, including cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision. Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment (that is, a combined patient and care giver outcome measure of clinically relevant improvement on process, performance, and competence scales) at three months after randomisation. Bootstrap methods used to determine confidence intervals for these measures. The intervention cost 1183 euros (848 pounds sterling, $1738) (95% confidence interval 1128 euros (808 pounds sterling, $1657) to 1239 euros (888 pounds sterling, $1820)) per patient and primary care giver unit at three months. Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were 1748 euros (1279 pounds sterling, $2621) lower in the intervention group, with the main cost savings in informal care. There was a significant difference in proportions of successful treatments of 36% at three months. The number needed to treat for successful treatment at three months was 2.8 (2.7 to 2.9). Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective, especially in terms of informal care giving."," BMJ. 2008 Jan 19;336(7636):134-8. ","Netherlands",2008,"Any dementia","Occupational therapy",null,null,null,"Cost-effectiveness",null,"Netherlands",null,"Any dementia","Occupational therapy","Cost-effectiveness",null,null,"2005:2009"]
[92,"Getsios D, Migliaccio-Walle K, Caro JJ. NICE cost-effectiveness appraisal of cholinesterase inhibitors: was the right question posed? Were the best tools used? Pharmacoeconomics. 2007;25(12):997-1006.",null,"Getsios D, Migliaccio-Walle K, Caro JJ."," NICE cost-effectiveness appraisal of cholinesterase inhibitors: was the right question posed? Were the best tools used? Pharmacoeconomics.","The National Institute for Health and Clinical Excellence (NICE) recently issued updated guidance on the use of cholinesterase inhibitors in the treatment of Alzheimer's disease. NICE initially recommended that cholinesterase inhibitors no longer be used, but final guidance restricted treatment to patients with disease of a moderately severe stage. This decision was based largely on results from a heavily criticised economic evaluation that used an adaptation of the Assessment of Health Economics in Alzheimer's Disease (AHEAD) model. As the developers of the AHEAD model, we examined the appropriateness of NICE's economic analyses and presentation of results. We attempted to replicate NICE's results by modifying the original AHEAD model. Sensitivity analyses were then run using the modified AHEAD model to evaluate the extent of uncertainty in predictions. The AHEAD(NICE) analyses resulted in an incremental cost-effectiveness ratio for galantamine of 82,000 pound per QALY gained (year 2003 values) from the perspective of the UK NHS and Personal Social Services. This was later revised to 46,000 pound per QALY, compared with < 9000 pound per discounted QALY gained (year 2001 values) in the original AHEAD model. Using our modified AHEAD with effectiveness estimates matching those of AHEAD(NICE), we show that NICE's choice and presentation of sensitivity analyses obscured the instability of their estimates. In the final NICE evaluation, the recommendation to delay treatment with cholinesterase inhibitors until patients have moderately severe disease was based on critical assumptions in the economic analyses that had little evidence to support them. The case of NICE's guidance on cholinesterase inhibitors highlights the importance of transparent and valid economic evaluations and the dangers of using inappropriate modelling technologies, basing analyses on a limited subset of the available data, and insufficiently reflecting the uncertainty in estimates that are intended to inform decision makers.\n"," 2007;25(12):997-1006.","UK",2007,"Alzheimer’s","Any anticholinesterase,Galantamine",null,null,null,"Cost-utility",null,"UK",null,"Alzheimer’s","Any anticholinesterase,Galantamine","Cost-utility",null,null,"2005:2009"]
[93,"Rosenheck RA, Leslie DL, Sindelar JL, Miller EA, Tariot PN, Dagerman KS, Davis SM, Lebowitz BD, Rabins P, Hsiao JK, Lieberman JA, Schneider LS, Clinical Antipsychotic Trial of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) investigators. Cost-benefit analysis of second-generation antipsychotics and placebo in a randomized trial of the treatment of psychosis and aggression in Alzheimer disease. Arch Gen Psychiatry. 2007 Nov;64(11):1259-68. ","doi: 10.1001/archpsyc.64.11.1259.","Rosenheck RA, Leslie DL, Sindelar JL, Miller EA, Tariot PN, Dagerman KS, Davis SM, Lebowitz BD, Rabins P, Hsiao JK, Lieberman JA, Schneider LS, Clinical Antipsychotic Trial of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) investigators."," Cost-benefit analysis of second-generation antipsychotics and placebo in a randomized trial of the treatment of psychosis and aggression in Alzheimer disease.","Second-generation antipsychotics (SGAs) are prescribed for psychosis, aggression, and agitation in Alzheimer disease (AD). To conduct a cost-benefit analysis of SGAs and placebo (taken to represent a \"watchful waiting\" treatment strategy) for psychosis and aggression in outpatients with AD. Randomized placebo-controlled trial of alternative SGA initiation strategies. Forty-two outpatient clinics. Outpatients with AD and psychosis, aggression, or agitation (N = 421). Intervention Participants were randomly assigned to treatment with olanzapine, quetiapine fumarate, risperidone, or placebo with the option of double-blind rerandomization to another antipsychotic or citalopram hydrobromide or open treatment over 9 months. Monthly interviews documented health service use and costs. The economic perspective addressed total health care and medication costs. Costs of study drugs were estimated from wholesale prices with adjustment for discounts and rebates. Quality-adjusted life-years (QALYs) were assessed with the Health Utilities Index Mark 3 and were supplemented with measures of functioning, activities of daily living, and quality of life. Primary analyses were conducted using all available data. Secondary analyses excluded observations after the first medication change (ie, phase 1 only). Cost-benefit analysis was conducted using the net health benefits approach in a sensitivity analysis in which QALYs were valued at $50,000 per year and $100,000 per year. Average total health costs, including medications, were significantly lower for placebo than for SGAs, by $50 to $100 per month. There were no differences between treatments in QALYs or other measures of function. Phase 1-only analyses were broadly similar. Net-benefit analysis showed greater net health benefits for placebo as compared with other treatments, with probabilities ranging from 50% to 90%. There were no differences in measures of effectiveness between initiation of active treatments or placebo (which represented watchful waiting) but the placebo group had significantly lower health care costs. clinicaltrials.gov Identifier: NCT00015548."," Arch Gen Psychiatry. 2007 Nov;64(11):1259-68. ","USA",2007,"Alzheimer’s","Antipsychotics",null,null,null,"Cost-benefit",null,"USA",null,"Alzheimer’s","Antipsychotics","Cost-benefit",null,null,"2005:2009"]
[94,"Gagnon M, Rive B, Hux M, Guilhaume C. Cost-effectiveness of memantine compared with standard care in moderate-to-severe Alzheimer disease in Canada. Can J Psychiatry. 2007 Aug;52(8):519-26.",null,"Gagnon M, Rive B, Hux M, Guilhaume C."," Cost-effectiveness of memantine compared with standard care in moderate-to-severe Alzheimer disease in Canada.","To conduct a cost-effectiveness analysis comparing the addition of memantine to standard care (that is, without acetylcholinesterase inhibitors) with standard care alone in moderate-to-severe Alzheimer disease (AD) in Canada. A 2-year Markov model estimated clinical effects in terms of quality-adjusted life years (QALYs) and time in complete dependence as well as societal costs in four 6-month cycles. Health states were defined by AD severity assessed with the Mini-Mental State Examination (moderate = 10 to 19; severe < 10), by level of dependence in activities of daily living, and by death. Transition probabilities were estimated by combining data of patients with moderate-to-severe AD from all relevant clinical trials. QALYs were estimated from a UK epidemiologic study. The initial distribution and use of medical and support services for each health state was obtained from the Canadian Study on Health and Aging with current estimates of frequency of use and unit prices applied. Compared with standard care, the memantine strategy saved more than 1 month of complete dependence and produced 0.03 additional QALYs, with no additional cost. Probabilistic sensitivity analyses give an 83.3% chance that memantine treatment is cost-neutral, an 89.5% chance of its being cost-effective if the decision maker is willing to pay $20 000 for a QALY, and a 96.2% chance with a willingness to pay $100 000 per QALY. Robustness of results was confirmed through 1-way and scenario-based sensitivity analyses. Our evaluation found that memantine monotherapy produced relevant health benefit, compared with standard care alone, with no additional costs. Results are consistent with other economic evaluations of memantine conducted in Europe and the United States."," Can J Psychiatry. 2007 Aug;52(8):519-26.","Canada",2007,"Alzheimer’s","Any anticholinesterase,Memantine",null,null,null,"Cost-utility",null,"Canada",null,"Alzheimer’s","Any anticholinesterase,Memantine","Cost-utility",null,null,"2005:2009"]
[95,"Ballard C, Sorensen S, Sharp S. Pharmacological therapy for people with Alzheimer's disease: the balance of clinical effectiveness, ethical issues and social and healthcare costs. J Alzheimers Dis. 2007 Aug;12(1):53-9.",null,"Ballard C, Sorensen S, Sharp S."," Pharmacological therapy for people with Alzheimer's disease: the balance of clinical effectiveness, ethical issues and social and healthcare costs.","The drive for evidence based practice and cost-effective use of pharmacological therapies has advantages, but can also be problematic. These difficulties are particularly challenging in the context of long-term conditions, such as Alzheimer's disease. The complexity of the illness, the variable and complex pattern of service use and the difficulty of conducting long term clinical trials are extremely difficult to factor into a meaningful cost effectiveness model. In Alzheimer's disease, the additional impact on caregivers as well as the person with dementia should be considered. In the current article we give a brief overview of the clinical effectiveness of cholinesterase inhibitors for the treatment of Alzheimer's disease, discuss in detail the NICE appraisal of these treatments in the UK as an example of an attempt at a standardised evaluation of cost-effectiveness and discuss a proposed way forward to achieve a unified and consistent approach to the assessment of cost-effectiveness for anti-dementia therapies."," J Alzheimers Dis. 2007 Aug;12(1):53-9.","UK",2007,"Alzheimer’s","Any anticholinesterase",null,null,null,"Unclear",null,"UK",null,"Alzheimer’s","Any anticholinesterase","Unclear",null,null,"2005:2009"]
[96,"Green C. Modelling disease progression in Alzheimer's disease: a review of modelling methods used for cost-effectiveness analysis. Pharmacoeconomics. 2007;25(9):735-50. ",null,"Green C."," Modelling disease progression in Alzheimer's disease: a review of modelling methods used for cost-effectiveness analysis.","The literature reporting economic evaluations related to the treatment of Alzheimer's disease (AD) has developed over the last decade. Most analyses have used economic models to estimate the cost effectiveness of drugs for the treatment of AD. This review considers the range of methods used in the published cost-effectiveness literature to model AD progression and the effect of interventions on the progression of AD. The review builds on and updates an earlier systematic review of cost-effectiveness studies on drugs for AD. Systematic and rigorous methods were used to search the literature for economic evaluations estimating the cost effectiveness of donepezil, rivastigmine, galantamine or memantine in AD. The literature search covered a wide range of electronic databases (e.g. MEDLINE, EMBASE), and included literature from the inception of databases up to the end of 2005. The search identified 22 published economic evaluations. An outline and brief critical review of the identified studies is provided, and thereafter the methods used to model disease progression were considered in more detail. The review employs recent guidance on good practice in decision-analytic modelling in HTA to critically review the modelling methods used. Using this guidance, the models are assessed against the broad criteria of model structure, data inputs and assessment of uncertainty and inconsistency. Concerns were noted over the model structure employed in all models. The reliance on cognitive scores to model AD, the progression of the disease, and the effect of treatment on costs and consequences is regarded as a serious limitation in almost all of the studies identified. There are also limitations over the data used to populate published models, especially around the failure of studies to document and establish the basis for the modelling of treatment effects. It is also clear that studies modelling AD progression, and subsequently the cost effectiveness of treatment, have not addressed uncertainty or consistency (internal and/or external) in sufficient detail. Further research is required on more appropriate methods for the modelling of AD progression. In the meantime, future economic evaluations of treatment need to be more explicit on the methods used to model AD, and the data used to populate models."," Pharmacoeconomics. 2007;25(9):735-50. ","International",2007,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine",null,null,null,"Unclear",null,"International",null,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine","Unclear",null,null,"2005:2009"]
[97,"Fuh JL, Wang SJ. Cost-effectiveness analysis of donepezil for mild to moderate Alzheimer's disease in Taiwan. Int J Geriatr Psychiatry. 2008 Jan;23(1):73-8. ","doi: 10.1002/gps.1842. ","Fuh JL, Wang SJ."," Cost-effectiveness analysis of donepezil for mild to moderate Alzheimer's disease in Taiwan.","Donepezil is a drug used for treatment in patients with Alzheimer's disease (AD). Information regarding the cost-effectiveness of this medication was previously rare in Asia. We used techniques of decision analysis and economic evaluation in conjunction with available local epidemiological and clinical data on costs of mild to moderate AD to assess the cost-effectiveness of donepezil in Taiwan. A four-state Markov model was built to simulate the disease progression of AD patients. Local transition probabilities and costs of different stages were from the studies published earlier. Over a 5-year span, donepezil treatment for mild or moderate AD patients is predicted to result in the gain of 0.505 QALYs when comparing to usual care, while at the same time reducing the cost by US$7,691. The incremental cost was US$3,647 from the payer perspective; thus, the incremental cost-effectiveness ratio was estimated to be US$7,226 when considering only the medical expenditures. Under some assumptions, donepezil treatment might be a cost saving strategy for mild to moderate AD patients in Taiwan from a societal perspective. It is inconclusive from the payer's part since we still lack a consensus for judging the cost-effectiveness of a new health care technology."," Int J Geriatr Psychiatry. 2008 Jan;23(1):73-8. ","Taiwan",2008,"Alzheimer’s","Donepezil",null,null,null,"Cost-utility",null,"Taiwan",null,"Alzheimer’s","Donepezil","Cost-utility",null,null,"2005:2009"]
[98,"Weycker D, Taneja C, Edelsberg J, Erder MH, Schmitt FA, Setyawan J, Oster G. Cost-effectiveness of memantine in moderate-to-severe Alzheimer's disease patients receiving donepezil. Curr Med Res Opin. 2007 May;23(5):1187-97. ","doi: 10.1185/030079907X188071. ","Weycker D, Taneja C, Edelsberg J, Erder MH, Schmitt FA, Setyawan J, Oster G."," Cost-effectiveness of memantine in moderate-to-severe Alzheimer's disease patients receiving donepezil.","The efficacy and safety of memantine in patients with moderate-to-severe Alzheimer's disease (AD) receiving stable doses of donepezil were recently demonstrated in a phase III trial. The cost-effectiveness of such therapy is unknown. A microsimulation model was developed to depict AD progression over time and associated clinical and economic outcomes. AD progression was measured in terms of decline in cognitive function, as assessed by the Severe Impairment Battery (SIB). At model entry, patients were assumed to have moderate-to-severe AD, to be on stable doses of donepezil, and to begin combination therapy with memantine, or continue to receive donepezil alone; duration of therapy was assumed to be 1 year. Drug efficacy was based on data from a phase III trial. Key assumptions of the model included: (1) efficacy of study drugs would extend to 1 year; (2) measures of cognitive function could be mapped to one another, as well as to global measures of disease severity; and (3) following therapy discontinuation, cognitive function would revert immediately to natural history levels. Cost-effectiveness was assessed in terms of cost (2005 US$) per quality-adjusted life-year (QALY) gained over a lifetime (3% discount rate). SIB scores were estimated to improve by 3.3 over 1 year from therapy with memantine plus donepezil (vs. donepezil alone). While pharmacotherapy costs were estimated to increase by $1250 during the year of memantine treatment, costs of formal and informal services were estimated to decrease by $1240 over this period and by $1493 (discounted present value) over a lifetime. Findings were sensitive to the assumed SIB score at therapy initiation; cost-effectiveness was better for patients with higher initial SIB scores (i.e., less severe disease). In patients with moderate-to-severe AD already receiving donepezil, treatment with memantine results in improved clinical outcomes and reduced total costs of care."," Curr Med Res Opin. 2007 May;23(5):1187-97. ","USA",2007,"Alzheimer’s","Donepezil,Memantine",null,null,null,"Cost-utility",null,"USA",null,"Alzheimer’s","Donepezil,Memantine","Cost-utility",null,null,"2005:2009"]
[99,"Mason A, Weatherly H, Spilsbury K, Arksey H, Golder S, Adamson J, Drummond M, Glendinning C. A systematic review of the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their carers. Health Technol Assess. 2007 Apr;11(15):1-157, iii.",null,"Mason A, Weatherly H, Spilsbury K, Arksey H, Golder S, Adamson J, Drummond M, Glendinning C."," A systematic review of the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their carers.","To review the evidence for different models of community-based respite care for frail older people and their carers, where the participant group included older people with frailty, disability, cancer or dementia. Where data permitted, subgroups of carers and care recipients, for whom respite care is particularly effective or cost-effective, were to be identified. Major databases were searched from 1980 to March 2005. Ongoing and recently completed research databases were searched in July 2005. Data from relevant studies were extracted and quality assessed. The possible effects of study quality on the effectiveness data and review findings were discussed. Where sufficient clinically and statistically similar data were available, data were pooled using appropriate statistical techniques. Twenty-two primary studies were included. Most of the evidence came from North America, with a minority of effectiveness and economic studies based in the UK. Types of service studied included day care, host family, in-home, institutional and video respite. Effectiveness evidence suggests that the consequences of respite upon carers and care recipients are generally small, with better controlled studies finding modest benefits only for certain subgroups. However, many studies report high levels of carer satisfaction. No reliable evidence was found that respite can delay entry to residential care or that respite adversely affects care recipients. Randomisation validity in the included randomised studies was sometimes unclear. Studies reported many different outcome measures, and all of the quasi-experimental and uncontrolled studies had methodological weaknesses. The descriptions of the studies did not provide sufficient detail of the methods of data collection or analysis, and the studies failed to describe adequately the groups of study participants. In some studies, only evidence to support respite care services was presented, rather than a balanced view of the services. Only five economic evaluations of respite care services were found, all of which compared day care with usual care and only one study was undertaken in the UK. Day care tended to be associated with higher costs and either similar or a slight increase in benefits, relative to usual care. The economic evaluations were based on two randomised and three quasi-experimental studies, all of which were included in the effectiveness analysis. The majority of studies assessed health and social service use and cost, but inadequate reporting limits the potential for exploring applicability to the UK setting. No study included generic health-related quality of life measures, making cost-effectiveness comparisons with other healthcare programmes difficult. One study used sensitivity analysis to explore the robustness of the findings. The literature review provides some evidence that respite for carers of frail elderly people may have a small positive effect upon carers in terms of burden and mental or physical health. Carers were generally very satisfied with respite. No reliable evidence was found that respite either benefits or adversely affects care recipients, or that it delays entry to residential care. Economic evidence suggests that day care is at least as costly as usual care. Pilot studies are needed to inform full-scale studies of respite in the UK."," Health Technol Assess. 2007 Apr;11(15):1-157, iii.","UK",2007,"Any dementia","Caregiver support",null,null,null,"Unclear",null,"UK",null,"Any dementia","Caregiver support","Unclear",null,null,"2005:2009"]
[100,"Teipel SJ, Ewers M, Reisig V, Schweikert B, Hampel H, Happich M. Long-term cost-effectiveness of donepezil for the treatment of Alzheimer's disease. Eur Arch Psychiatry Clin Neurosci. 2007 Sep;257(6):330-6. ","doi: 10.1007/s00406-007-0727-1. ","Teipel SJ, Ewers M, Reisig V, Schweikert B, Hampel H, Happich M."," Long-term cost-effectiveness of donepezil for the treatment of Alzheimer's disease.","(Acetyl-)cholinesterase (ChE) inhibitors have been approved for the treatment of mild to moderate Alzheimer's disease (AD). However, use of ChE inhibitors is limited by budget constraints and disincentives on the side of health insurances and nursing care insurances. To analyse under what conditions the application of the acetylcholinesterase inhibitor donepezil is favourable for the treatment of patients with AD from the perspective of health insurance and nursing care insurance companies in Germany, taking into account factors such as start and duration of treatment, duration of follow-up, drug costs, internalization of opportunity costs and varying mortality and efficacy rates. Transition probabilities from a Swedish study and German cost data for donepezil were merged in a Markov model to follow a cohort of patients over a period of 5-10 years. We defined a base case with 1 year treatment and follow-up over 5 years and varied treatment length, follow-up interval and cost factors in sensitivity analyses. In the base case, the ChE inhibitor donepezil did not lead to cost savings but to a cost-effective outcome on side of health insurances and nursing care insurances. Early treatment of AD and internalization of opportunity costs (caring time devoted to patients) led to less costs per quality adjusted life years gained. However, results are very sensitive with respect to varying mortality and efficacy rates. The application of donepezil may be cost-effective, but considerable uncertainties remain. Moreover, the way the reimbursement system in Germany is presently arranged does not support the application of ChE inhibitors."," Eur Arch Psychiatry Clin Neurosci. 2007 Sep;257(6):330-6. ","Germany",2007,"Alzheimer’s","Donepezil",null,null,null,"Cost-utility",null,"Germany",null,"Alzheimer’s","Donepezil","Cost-utility",null,null,"2005:2009"]
[101,"Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B, Orrell M. Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis. Br J Psychiatry. 2006 Jun;188():574-80. ","doi: 10.1192/bjp.bp.105.010561.","Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B, Orrell M."," Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis.","Psychological therapy groups for people with dementia are widely used, but their cost-effectiveness has not been explored. To investigate the cost-effectiveness of an evidence-based cognitive stimulation therapy (CST) programme for people with dementia as part of a randomised controlled trial. A total of 91 people with dementia, living in care homes or the community, received a CST group intervention twice weekly for 8 weeks; 70 participants with dementia received treatment as usual. Service use was recorded 8 weeks before and during the 8-week intervention and costs were calculated. A cost-effectiveness analysis was conducted with cognition as the primary outcome, and quality of life as the secondary outcome. Cost-effectiveness acceptability curves were plotted. Cognitive stimulation therapy has benefits for cognition and quality of life in dementia, and costs were not different between the groups. Under reasonable assumptions, there is a high probability that CST is more cost-effective than treatment as usual, with regard to both outcome measures. Cognitive stimulation therapy for people with dementia has effectiveness advantages over, and may be more cost-effective than, treatment as usual."," Br J Psychiatry. 2006 Jun;188():574-80. ","UK",2006,"Any dementia","Cognitive therapies",null,null,null,"Cost-utility",null,"UK",null,"Any dementia","Cognitive therapies","Cost-utility",null,null,"2005:2009"]
[102,"Kirby J, Green C, Loveman E, Clegg A, Picot J, Takeda A, Payne E. A systematic review of the clinical and cost-effectiveness of memantine in patients with moderately severe to severe Alzheimer's disease. Drugs Aging. 2006;23(3):227-40.",null,"Kirby J, Green C, Loveman E, Clegg A, Picot J, Takeda A, Payne E."," A systematic review of the clinical and cost-effectiveness of memantine in patients with moderately severe to severe Alzheimer's disease.","Alzheimer's disease (AD) is the most common form of dementia and is characterised by a worsening of cognition, functional ability, and behaviour and mood. The objective of this study was to review the clinical and cost-effectiveness of memantine for the treatment of patients with moderately severe to severe AD. To achieve this, a systematic search and review of the clinical and cost effectiveness literature for memantine was undertaken. The literature search covered the period from the inception of MEDLINE, Cochrane Library, EMBASE and other electronic databases until July 2004. The search included randomised controlled trials (RCTs) and full economic evaluations that assessed the use of memantine in patients with moderately severe to severe AD. Two published RCTs were included in this review; in one of these trials the participants were already being treated with donepezil. The two RCTs showed benefit for patients receiving memantine compared with placebo on the outcome measures of the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory modified for severe dementia, the Clinician's Interview-Based Impression of Change Plus Caregiver Input, and the Severe Impairment Battery, and that memantine appeared to be slightly more effective in patients already receiving a stable dose of donepezil. Five cost-effectiveness studies were included in the review. Although these studies reported cost reductions and improved outcomes with memantine, the evaluations were based on a number of assumptions. In conclusion, memantine appears to be beneficial when assessed using functional and global measurements. However, the effect of memantine on cognitive scores and behaviour and mood outcomes is less clear. Cost-effectiveness is dependent upon assumptions surrounding clinical effect and context-specific cost data."," Drugs Aging. 2006;23(3):227-40.","International",2006,"Alzheimer’s","Donepezil,Memantine",null,null,null,"Unclear",null,"International",null,"Alzheimer’s","Donepezil,Memantine","Unclear",null,null,"2005:2009"]
[103,"Willan AR, Goeree R, Pullenayegum EM, McBurney C, Blackhouse G. Economic evaluation of rivastigmine in patients with Parkinson's disease dementia. Pharmacoeconomics. 2006;24(1):93-106. ",null,"Willan AR, Goeree R, Pullenayegum EM, McBurney C, Blackhouse G."," Economic evaluation of rivastigmine in patients with Parkinson's disease dementia.","The positive results of a randomised clinical trial of rivastigmine in patients with dementia associated with Parkinson's disease have been published recently. Patient-level healthcare utilisation data were also collected, and this report is the economic evaluation based on these data. To determine the cost effectiveness of rivastigmine 3-12 mg/day in patients in whom mild to moderate dementia developed at least 2 years after they received a clinical diagnosis of Parkinson's disease. A cost-effectiveness analysis was performed by applying Canadian and UK cost weights (year 2004 values) to healthcare utilisation data collected prospectively during a randomised, double-blind, multinational, 24-week trial of rivastigmine 3-12 mg/day (n = 362) versus placebo (n = 179). Patients were > or =50 years of age, had a Mini-Mental State Examination (MMSE) score of between 20 and 24 and had contact with a responsible caregiver at least 3 days a week.Quality-adjusted survival time, transformed from MMSE scores, was the measure of effectiveness. Caregiver costs included paid and unpaid time, and direct costs included concomitant medications, outpatient care, hospitalisations, long-term care and study medications. Analysis was conducted from a societal perspective with a time horizon of 24 weeks. Consistent with the improvement in clinical outcomes, there was an observed increase in quality-adjusted survival time in the rivastigmine arm of 2.81 quality-adjusted life-days (two-sided p-value 0.13 [90% CI -0.243, 5.86]). Using Canadian price weights, there was an observed increase in cost in the rivastigmine arm of Can 55.76 dollars(two-sided p-value 0.98 [90% CI -3431, 3543]), with a resulting incremental cost-effectiveness ratio of Can 7429 dollars per QALY. Using UK price weights, there was an observed decrease in cost in the rivastigmine arm of pound 26.18 (two-sided p-value 0.99 [90% CI -2407, 2355]). Although no between-treatment differences in cost were seen, the small sample size, highly variable cost distributions and short time horizon prevent us from making strong conclusions with regard to the effect of rivastigmine on total costs and, by inference, on cost effectiveness."," Pharmacoeconomics. 2006;24(1):93-106. ","Canada,UK",2006,"Parkinson’s dementia","Rivastigmine",null,null,null,"Cost-utility",null,"Canada,UK",null,"Parkinson’s dementia","Rivastigmine","Cost-utility",null,null,"2005:2009"]
[104,"Loveman E, Green C, Kirby J, Takeda A, Picot J, Payne E, Clegg A. The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease. Health Technol Assess. 2006 Jan;10(1):iii-iv, ix-xi, 1-160.",null,"Loveman E, Green C, Kirby J, Takeda A, Picot J, Payne E, Clegg A."," The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease.","To provide an update review of the best quality evidence for the clinical effectiveness and cost-effectiveness of donepezil, rivastigmine and galantamine for mild to moderately severe Alzheimer's disease (AD) and of memantine for moderately severe to severe AD. Electronic databases, experts in the field and manufacturer submissions to the National Institute for Health and Clinical Excellence (NICE). A systematic review of the literature and an economic evaluation were undertaken. The quality of included randomised controlled trials (RCTs) was assessed using criteria developed by the NHS Centre for Reviews and Dissemination. An outline assessment of economic evaluations was undertaken using a standard checklist. The clinical and cost-effectiveness data were synthesised through a narrative review with full tabulation of the results of included studies. Where appropriate, meta-analysis of data was undertaken. For mild to moderately severe AD, the results of the study suggested that all three treatments were beneficial when assessed using cognitive outcome measures. Global outcome measures were positive for donepezil and rivastigmine, but mixed for galantamine. Results for measures of function were mixed for donepezil and rivastigmine, but positive for galantamine. Behaviour and mood measures were mixed for donepezil and galantamine, but showed no benefit for rivastigmine. For memantine, two published RCTs were included; in one of these trials the participants were already being treated with donepezil. The results suggest that memantine is beneficial when assessed using functional and global measurements. The effect of memantine on cognitive and behaviour and mood outcomes is, however, less clear. Literature on the cost-effectiveness of donepezil, rivastigmine and galantamine was dominated by industry-sponsored studies, and studies varied in methods and results. Of the three UK studies, two report donepezil as not cost-effective, whereas a third study reports an additional cost (1996 pounds sterling) of between 1200 pounds sterling and 7000 pounds sterling per year in a non-severe AD health state (concerns over these estimates are raised, suggesting that they may underestimate the true cost-effectiveness of donepezil). Cost-effectiveness analysis undertaken in this review suggests that donepezil treatment has a cost per quality-adjusted life-year (QALY) in excess of 80,000 pounds sterling, with donepezil treatment reducing the mean time spent in full-time care (delays progression of AD) by 1.42-1.59 months (over a 5-year period). From four published cost-effectiveness studies, two UK studies report additional costs associated with rivastigmine treatment. Cost-effectiveness analysis undertaken in the current review suggests that rivastigmine treatment has a cost per QALY in excess of 57,000 pounds sterling, with rivastigmine treatment reducing the mean time spent in full-time care (delays progression) by 1.43-1.63 months (over a 5-year period). From five published cost-effectiveness studies, one UK study reports a cost per QALY of 8693 pounds sterling for 16-mg galantamine treatment and 10,051 pounds sterling for 24-mg galantamine treatment (concerns raised suggest that this may underestimate the true cost-effectiveness of galantamine). Cost-effectiveness analysis undertaken in the present review suggests that galantamine treatment has a cost per QALY in excess of 68,000 pounds sterling, with galantamine reducing the time spent in full-time care (delays progression) by 1.42-1.73 months (over a 5-year period). From two published cost-effectiveness studies, one reports analysis for the UK, finding that memantine treatment results in cost savings and benefits in terms of delaying disease progression (concerns raised suggest that this may underestimate the true cost-effectiveness of memantine). In the current review, the cost-effectiveness of memantine has not been modelled separately, but where alternative parameter inputs on the cost structure and utility values have been used in a reanalysis using the industry model, the cost-effectiveness is reported at between 37,000 pounds sterling and 52,000 pounds sterling per QALY, with this alternative analysis still based on what is regarded as an optimistic or favourable effectiveness profile for memantine. Although results from the clinical effectiveness review suggest that these treatments may be beneficial, a number of issues need to be considered when assessing the results of the present review, such as the characteristics of the participants included in the individual trials, the outcome measures used, the length of study duration, the effects of attrition and the relationship between statistical significance and clinical significance. Many included trials were sponsored by industry. For donepezil, rivastigmine and galantamine, the cost savings associated with reducing the mean time spent in full-time care do not offset the cost of treatment sufficiently to bring estimated cost-effectiveness to levels generally considered acceptable by NHS policy makers. It is difficult to draw conclusions on the cost-effectiveness of memantine; it is suggested that further amendments to the potentially optimistic industry model (measure of effect) would offer higher cost per QALY estimates. Future research should include: information on the quality of the outcome measures used; development of quality of life instruments for patients and carers; studies assessing the effects of these interventions of durations longer than 12 months; comparisons of benefits between interventions; and research on the prediction of disease progression."," Health Technol Assess. 2006 Jan;10(1):iii-iv, ix-xi, 1-160.","UK",2006,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine",null,null,null,"Cost-utility",null,"UK",null,"Alzheimer’s","Donepezil,Galantamine,Memantine,Rivastigmine","Cost-utility",null,null,"2005:2009"]
[105,"Jansen AP, van Hout HP, van Marwijk HW, Nijpels G, de Bruijne MC, Bosmans JE, Pot AM, Stalman WA. (Cost)-effectiveness of case-management by district nurses among primary informal caregivers of older adults with dementia symptoms and the older adults who receive informal care: design of a randomized controlled trial [ISCRTN83135728]. BMC Public Health. 2005 Dec 12;5():133. ","doi: 10.1186/1471-2458-5-133. ","Jansen AP, van Hout HP, van Marwijk HW, Nijpels G, de Bruijne MC, Bosmans JE, Pot AM, Stalman WA."," (Cost)-effectiveness of case-management by district nurses among primary informal caregivers of older adults with dementia symptoms and the older adults who receive informal care: design of a randomized controlled trial [ISCRTN83135728].","Dementia is an incurable disease with devastating consequences for both patients and their relatives. The objective of this study is to describe the study protocol of a randomized controlled trial with assignment to either usual care or case-management by district nurses, among informal caregivers of older adults with dementia symptoms who live at home and the older adults who receive informal care. In this randomized controlled trial, effectiveness as well as cost-effectiveness of case-management is evaluated. It concerns case-management in early-detected patients with dementia symptoms and their primary informal caregivers. Participants are followed up to twelve months after baseline assessment. The main outcome measure of the effect evaluation is the caregiver's sense of competence to care for the older person with dementia symptoms. The economic evaluation is performed from a societal perspective. This is one of the first trials on case-management that includes an economic evaluation. In addition, it concerns a tailor-made intervention in early-detected patients with dementia symptoms and their caregivers. The results of this randomized controlled trial will provide valuable information for health professionals and policy makers on effectiveness and cost-effectiveness of early tailor-made case-management for patients and their informal caregivers. Moreover, positive effects will challenge current health care systems to move to more pro-active approaches for this group."," BMC Public Health. 2005 Dec 12;5():133. ","Netherlands",2005,"Any dementia","Disease management",null,null,null,"Unclear",null,"Netherlands",null,"Any dementia","Disease management","Unclear",null,null,"2005:2009"]
[106,"Green C, Picot J, Loveman E, Takeda A, Kirby J, Clegg A. Modelling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderately severe Alzheimer's disease. Pharmacoeconomics. 2005;23(12):1271-82. ",null,"Green C, Picot J, Loveman E, Takeda A, Kirby J, Clegg A."," Modelling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderately severe Alzheimer's disease.","To estimate the cost effectiveness (from the UK NHS and personal social services perspective) of the cholinesterase inhibitors donepezil, rivastigmine and galantamine compared with usual care in the treatment of mild to moderately severe Alzheimer's disease. Patients had a mean age of 74 years, a mean disease duration of 1 year and a mean Alzheimer's disease assessment scale-cognitive subscale score of 24. A pharmacoeconomic model was used to predict long-term outcomes over a 5-year time horizon and to estimate the cost effectiveness of cholinesterase inhibitors for the management of Alzheimer's disease. The model structure is informed by a systematic review of the literature on the clinical and cost effectiveness of cholinesterase inhibitors and a review of the literature on the costs and outcomes associated with treatment for Alzheimer's disease. The main outcome measure used was the cost per quality-adjusted life-year (QALY) gained. All healthcare costs (excluding cholinesterase inhibitor costs) were indexed to pounds sterling (2003 values). Drug costs are 2005 values. Multivariate probabilistic sensitivity analysis and scenario analysis were undertaken to assess uncertainty in the results. The clinical benefits on cognition from treatment with cholinesterase inhibitors resulted in an incremental cost per QALY gained ranging from 53,780 pounds sterling to 74,735 pounds sterling, over 5 years (vs usual care). Uncertainty analysis suggests that the probability of any of these treatments having an incremental cost per QALY of < 30,000 pounds sterling is < 21%. The key determinants of cost effectiveness were the effectiveness of treatment, the mean treatment cost and the cost savings associated with an expected delay in disease progression. Results presented in this paper suggest that the use of cholinesterase inhibitors may not be a cost-effective use of NHS resources. Guidance from the National Institute for Health and Clinical Effectiveness (NICE) in the UK on their judgements surrounding the acceptability of technologies as an effective use of resources, indicates there would need to be special reasons for accepting cholinesterase inhibitors as a cost-effective use of NHS resources."," Pharmacoeconomics. 2005;23(12):1271-82. ","UK",2005,"Alzheimer’s","Donepezil,Galantamine,Rivastigmine,",null,null,null,"Cost-utility",null,"UK",null,"Alzheimer’s","Donepezil,Galantamine,Rivastigmine,Other,Antidepressants,Antipsychotics,Any anticholinesterase,Behavioural therapies,Caregiver support,Cognitive therapies,Deep brain stimulation,Diagnosis,Diet,Disease management,Donepezil,Exercise,Formal care,Galantamine,Informal care,Memantine,Memory clinic,None or unclear,Occupational therapy,Other psychological therapies,Prevention,Rivastigmine,Support,Telecare","Cost-utility",null,null,"2005:2009"]
[107,"Jönsson L. Cost-effectiveness of memantine for moderate to severe Alzheimer's disease in Sweden. Am J Geriatr Pharmacother. 2005 Jun;3(2):77-86. ","doi: 10.1016/j.amjopharm.2005.05.002.","Jönsson L."," Cost-effectiveness of memantine for moderate to severe Alzheimer's disease in Sweden.","Alzheimer's disease entails enormous costs for society and impairs quality of life for patients and caregivers. This study estimated the cost-effectiveness of memantine in the treatment of patients with moderately severe to severe cognitive impairment from Alzheimer's disease in Sweden. The study was based on published data from several sources, including a randomized controlled trial of memantine versus placebo and a longitudinal observational study of Alzheimer's disease patients in Sweden. Costs were estimated from the public payer's perspective, including direct costs but excluding costs of informal care, and resource utilization data were taken from the observational study. Cost-effectiveness was quantified as quality-adjusted life-years (QALYs) gained from treatment with the use of previously published utility weights. A Markov simulation model was constructed, incorporating the effect of treatment on cognitive function, physical dependence related to activities of daily living, and institutionalization. Costs and effects for treated and untreated patients were estimated for 5 years (10 cycles). In the base-case analysis, treatment costs were added for 2 years, but the effect on transition probabilities was applied only for the first year of treatment. Compared with no treatment, memantine treatment was predicted to be associated with lower costs of care, longer time to dependence and institutionalization, and gains in QALYs. Treatment was estimated to decrease formal care costs by 123,600 Swedish kronor (SEK) and, after taking into account the cost of memantine, to lead to net cost savings of 100,528 SEK per patient. Treated patients gained 0.148 QALY over the 5-year simulation. From a public payer's perspective, the observed effect of memantine on cognitive and physical function is predicted to translate into economic benefits that offset the added treatment cost. Treatment is also predicted to delay institutionalization, improve independence, and increase QALYs."," Am J Geriatr Pharmacother. 2005 Jun;3(2):77-86. ","Sweden",2005,"Alzheimer’s","Memantine",null,null,null,"Cost-utility",null,"Sweden",null,"Alzheimer’s","Memantine","Cost-utility",null,null,"2005:2009"]
[108,"Plosker GL, Lyseng-Williamson KA. Memantine: a pharmacoeconomic review of its use in moderate-to-severe Alzheimer's disease. Pharmacoeconomics. 2005;23(2):193-206.",null,"Plosker GL, Lyseng-Williamson KA."," Memantine: a pharmacoeconomic review of its use in moderate-to-severe Alzheimer's disease.","Memantine (Ebixa, Namenda, Axura) is an uncompetitive NMDA receptor antagonist used in the management of patients with moderate-to-severe Alzheimer's disease. It is currently the only drug approved for use in these more advanced stages of the disease. Significant reductions in functional and cognitive decline have been demonstrated with memantine relative to placebo in randomised, double-blind trials in this patient population. Clinical trial and postmarketing surveillance data indicate that the drug is generally well tolerated. Two fully published modelled cost-effectiveness analyses of memantine in moderate-to-severe Alzheimer's disease have been conducted in the UK and Finland, in which patient progression was simulated through health states related to dependency, residential setting and cognitive function. Although the specific costs included in the analyses varied, as did the study perspective and geographical location, results of the base-case analyses consistently showed that memantine was dominant over no pharmacological treatment. In the UK and Finnish analyses, memantine increased the duration of independence by 1.3 and 4.1 months, respectively, and the time to institutionalisation by 0.8 and 1 month. Mean total per-patient costs were reduced by 1963 pounds over 2 years (2003 costs) in the UK analysis and by 1687 eurossover 5 years (2001 costs) in the Finnish analysis. Memantine was also associated with a small gain in quality-adjusted life expectancy in the UK model. In sensitivity analyses, memantine remained dominant for almost all plausible changes to key variables. Memantine reduced total societal costs by $1090 per patient per month (1999 costs) compared with no pharmacological treatment over 28 weeks in a resource utilisation and cost analysis conducted alongside a pivotal US trial in patients with moderate-to-severe Alzheimer's disease. Results were primarily driven by reductions in total caregiver costs, which included the opportunity cost of time spent in caregiving tasks, and in direct nonmedical costs, which included the cost of care in a nursing home or similar institution.In conclusion, in patients with moderate-to-severe Alzheimer's disease, memantine is associated with significant reductions in functional and cognitive decline compared with no pharmacological treatment. Available pharmacoeconomic data from Europe and the US, despite some inherent limitations, support the use of memantine as a cost-effective treatment in this patient population, although definitive conclusions are not feasible because of limited data."," Pharmacoeconomics. 2005;23(2):193-206.","International",2005,"Alzheimer’s","Memantine",null,null,null,"Cost-utility",null,"International",null,"Alzheimer’s","Memantine","Cost-utility",null,null,"2005:2009"]
[109,"Martikainen J, Valtonen H, Pirttilä T. Potential cost-effectiveness of a family-based program in mild Alzheimer's disease patients. Eur J Health Econ. 2004 Jun;5(2):136-42. ","doi: 10.1007/s10198-003-0214-1.","Martikainen J, Valtonen H, Pirttilä T."," Potential cost-effectiveness of a family-based program in mild Alzheimer's disease patients.","Alzheimer's disease (AD) is a chronic and progressive neurodegenerative disease characterized by a progressive deterioration in cognitive functions. AD will have a major impact on public health in the coming decades. The objective of this study was to evaluate the potential cost-effectiveness of a cognitive-behavioral family intervention (CBFI) program in patients with mild Alzheimer's disease in Finland. A second-order Monte Carlo technique was used to simulate the effectiveness of the intervention in AD patients and their informal caregivers over the course of 5 years. A Bayesian approach was applied to answer the question: how likely is it that the CBFI program is cost-effective? Based on existing information, the incremental net health benefit of the CBFI program is positive with over 0.9 probability, which indicates that the CBFI program has the highest probability of being optimal by providing greater net benefits than current practice. Furthermore, changes in the health-related quality of life of the caregivers were insensitive to AD patients' disease stage and settings of care. From the methodological point of view, the acceptability curve with a Bayesian approach provides a flexible way to characterize uncertainty surrounding cost-effectiveness parameters."," Eur J Health Econ. 2004 Jun;5(2):136-42. ","Finland",2004,"Alzheimer’s","Other psychological therapies",null,null,null,"Cost-utility",null,"Finland",null,"Alzheimer’s","Other psychological therapies","Cost-utility",null,null,"2000:2004"]
[110,"Jones RW, McCrone P, Guilhaume C. Cost effectiveness of memantine in Alzheimer's disease: an analysis based on a probabilistic Markov model from a UK perspective. Drugs Aging. 2004;21(9):607-20.",null,"Jones RW, McCrone P, Guilhaume C."," Cost effectiveness of memantine in Alzheimer's disease: an analysis based on a probabilistic Markov model from a UK perspective.","Clinical trials with memantine, an uncompetitive moderate-affinity NMDA antagonist, have shown improved clinical outcomes, increased independence and a trend towards delayed institutionalisation in patients with moderately severe-to-severe Alzheimer's disease. In a randomised double-blind, placebo-controlled, 28-week study conducted in the US, reductions in resource utilisation and total healthcare costs were noted with memantine relative to placebo. While these findings suggest that, compared with placebo, memantine provides cost savings, further analyses may help to quantify potential economic gains over a longer treatment period. To evaluate the cost effectiveness of memantine therapy compared with no pharmacological treatment in patients with moderately severe-to-severe Alzheimer's disease over a 2-year period. A Markov model was constructed to simulate patient progression through a series of health states related to severity, dependency (determined by patient scores on the Alzheimer's Disease Cooperative Study-Activities of Daily Living [ADCS-ADL] inventory and residential status ('institutionalisation') with a time horizon of 2 years (each 6-month Markov cycle was repeated four times). Transition probabilities from one health state to another 6 months later were mainly derived from a 28-week, randomised, double-blind, placebo-controlled clinical trial. Inputs related to epidemiological and cost data were derived from a UK longitudinal epidemiological study, while data on quality-adjusted life-years (QALYs) were derived from a Danish longitudinal study. To ensure conservative estimates from the model, the base case analysis assumed drug effectiveness was limited to 12 months. Monte Carlo simulations were performed for each state parameter following definition of a priori distributions for the main variables of the model. Sensitivity analyses included worst case scenario in which memantine was effective for 6 months and one-way sensitivity analyses on key parameters. Finally, a subgroup analysis was performed to determine which patients were most likely to benefit from memantine. Informal care was not included in this model as the costs were considered from National Health Service and Personal Social Services perspective. The base case analysis found that, compared with no treatment, memantine was associated with lower costs and greater clinical effectiveness in terms of years of independence, years in the community and QALYs. Sensitivity analyses supported these findings. For each category of Alzheimer's disease patient examined, treatment with memantine was a cost-effective strategy. The greatest economic gain of memantine treatment was in independent patients with a Mini-Mental State Examination score of > or =10. This model suggests that memantine treatment is cost effective and provides cost savings compared with no pharmacological treatment. These benefits appear to result from prolonged patient independence and delayed institutionalisation for moderately severe and severe Alzheimer's disease patients on memantine compared with no pharmacological treatment."," Drugs Aging. 2004;21(9):607-20.","UK",2004,"Alzheimer’s","Memantine",null,null,null,"Cost-utility",null,"UK",null,"Alzheimer’s","Memantine","Cost-utility",null,null,"2000:2004"]
[111,"Wimo A. Cost effectiveness of cholinesterase inhibitors in the treatment of Alzheimer's disease: a review with methodological considerations. Drugs Aging. 2004;21(5):279-95. ",null,"Wimo A."," Cost effectiveness of cholinesterase inhibitors in the treatment of Alzheimer's disease: a review with methodological considerations.","Cholinesterase inhibitors have been available for the treatment of Alzheimer's disease since 1993. They have significantly positive effects on cognitive functioning and other domains of functional capacity, such as activities of daily life in terms of efficacy, but the clinical value of these effects are under discussion. Cholinesterase inhibitors may also influence behavioural and psychological symptoms in Alzheimer's disease. Cholinesterase inhibitors are also regarded as rather expensive and, therefore, the question of cost effectiveness is essential. Pharmacoeconomic evaluations of cholinesterase inhibitors have so far been conducted in retrospect on efficacy data from prospective randomised clinical trials combined with economic data from other sources. There are no published specific cost-effectiveness studies of cholinesterase inhibitors which prospectively collected empirical data on costs and outcomes. There is only one published randomised clinical trial with such empirical data with a cost consequence analysis design, indicating cost neutrality. Several types of models to describe the long-term effects have been published, indicating cost effectiveness. However, due to methodological considerations, the validity of these models is difficult to judge. A research agenda for the cost effectiveness of cholinesterase inhibitors is proposed, including long-term studies with empirical data on resource use, costs and outcomes, studies on quality of life, informal care and behavioural and psychological symptoms, combination and comparative studies on mild cognitive impairment."," Drugs Aging. 2004;21(5):279-95. ","International",2004,"Alzheimer’s","Any anticholinesterase",null,null,null,"Unclear",null,"International",null,"Alzheimer’s","Any anticholinesterase","Unclear",null,null,"2000:2004"]
[112,"McMahon PM, Araki SS, Sandberg EA, Neumann PJ, Gazelle GS. Cost-effectiveness of PET in the diagnosis of Alzheimer disease. Radiology. 2003 Aug;228(2):515-22. ","doi: 10.1148/radiol.2282020915. ","McMahon PM, Araki SS, Sandberg EA, Neumann PJ, Gazelle GS."," Cost-effectiveness of PET in the diagnosis of Alzheimer disease.","To evaluate the cost-effectiveness of positron emission tomography (PET) in the diagnosis of Alzheimer disease (AD) in community-dwelling patients with mild or moderate dementia who present to specialized AD centers. A decision-analytic model was used to compare costs and quality-adjusted life years (QALYs) associated with strategies involving single photon emission computed tomography (SPECT), dynamic susceptibility-weighted contrast material-enhanced magnetic resonance (MR) imaging, and PET as functional imaging adjuncts to the standard clinical work-up. Sensitivity analyses were performed to examine changes in test characteristics, health-related quality-of-life survey instruments, therapeutic effectiveness, and treatment rules. The use of PET to confirm the results of the standard clinical work-up cost more but yielded fewer benefits than a strategy in which dynamic susceptibility-weighted contrast-enhanced MR imaging was substituted for the typically performed structural computed tomography. This relationship remained stable in scenarios in which standard diagnostic work-up accuracy, drug treatment effectiveness, and version of the Health Utilities Index were altered. Dynamic susceptibility-weighted contrast-enhanced MR imaging cost US dollars 598800 per QALY gained (range, US dollars 74400 to US dollars 1.9 million per QALY), compared with the cost of the standard diagnostic work-up. Treating all patients with dementia was the dominant imaging strategy, except when side effects in patients with non-AD-related dementia were modeled. In all scenarios, SPECT yielded fewer benefits than other strategies at a higher cost. PET may have high diagnostic accuracy, but adding it to the standard diagnostic regimen at AD clinics would yield limited, if any, benefits at very high costs."," Radiology. 2003 Aug;228(2):515-22. ","USA",2003,"Alzheimer’s","Diagnosis",null,null,null,"Cost-utility",null,"USA",null,"Alzheimer’s","Diagnosis","Cost-utility",null,null,"2000:2004"]
[113,"Leung GM, Yeung RY, Chi I, Chu LW. The economics of Alzheimer disease. Dement Geriatr Cogn Disord. 2003;15(1):34-43. ","doi: 66675. ","Leung GM, Yeung RY, Chi I, Chu LW."," The economics of Alzheimer disease.","Economic assessments of health and healthcare have become an integral part of policy decisions in the last decade. Increasingly, this trend is extending to medical decision-making in day-to-day patient-provider interactions. Alzheimer disease (AD) offers a potent example of the clinical and economic issues at stake with its diagnostic techniques, pharmacotherapies, and public health and policy implications. This review introduces basic economic concepts in examining the impact of AD and related care. It presents a summary of the latest economics research on cost estimates of AD and on economic evaluations of diagnostic and management interventions in terms of cost-of-illness and cost-effectiveness studies respectively. Empirical and conceptual issues about the interpretation of costs and the uses of evaluative methods are also discussed. We found that the economic costs attributable to AD care is highly variable mostly due to non-standardised methodologies and geographical variations in care patterns. There is, however, little doubt that the impact is substantial and is expected to worsen with the demographic, epidemiologic, technologic and economic transitions worldwide. There are comparatively fewer studies on the cost-effectiveness of interventions in AD. Most of the published work revolves around pharmacotherapeutics while relatively little has been done on diagnostics, patient care programmes and programmes for caregivers. We conclude that there are significant opportunities to strengthen research on standardised cost-of-illness analyses and new cost-effectiveness studies on a broader range of AD interventions."," Dement Geriatr Cogn Disord. 2003;15(1):34-43. ","International",2003,"Alzheimer’s","None or unclear",null,null,null,"Unclear",null,"International",null,"Alzheimer’s","None or unclear","Unclear",null,null,"2000:2004"]
[114,"Clegg A, Bryant J, Nicholson T, McIntyre L, De Broe S, Gerard K, Waugh N. Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for Alzheimer's disease. A systematic review. Int J Technol Assess Health Care. 2002 Summer;18(3):497-507.",null,"Clegg A, Bryant J, Nicholson T, McIntyre L, De Broe S, Gerard K, Waugh N."," Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for Alzheimer's disease.","Systematic review of the clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for people suffering from Alzheimer's disease. Sixteen electronic databases (including MEDLINE, the Cochrane Library, and Embase) and bibliographies of related papers were searched for published/unpublished English language studies, and experts and pharmaceutical companies were consulted for additional information. Randomized controlled trials (RCTs) and economic studies were selected. Clinical effectiveness was assessed on measurement scales assessing progression of Alzheimer's disease on the person's global health, cognition, functional ability, behavior and mood, and quality of life. Cost-effectiveness was presented as incremental cost per year spent in a nonsevere state (by Mini Mental Health State Examination) or quality-adjusted life-year. Twelve of 15 RCTs included were judged to be of good quality. Although donepezil had beneficial effects in Alzheimer's patients on global health and cognition, rivastigmine on global health, and galantamine on global health, cognition, and functional scales, these improvements were small and may not be clinically significant. Measures of quality of life and behavior and mood were rarely assessed. Adverse effects were usually mild and transient. Cost-effectiveness base case estimates ranged from 2,415 Pounds savings to 49,476 Pounds additional cost (1997 prices) per unit of effect for donepezil and a small savings for rivastigmine. Estimates were not considered robust or generalizable. Donepezil, rivastigmine, and galantamine appear to have some clinical effect for people with Alzheimer's disease, although the extent to which these translate into real differences in everyday life remains unclear. Due to the nature of current economic studies, cost-effectiveness remains uncertain and the impact on different care sectors has been inadequately investigated. Further research is needed to establish the actual benefits of acetylcholinesterase inhibitors (AChEls) for people with Alzheimer's disease and their caregivers, the relationship of these changes to clinical management, and careful prospective evaluation of resource and budgetary consequences."," A systematic review. Int J Technol Assess Health Care. 2002 Summer;18(3):497-507.","International",2002,"Alzheimer’s","Donepezil,Galantamine,Rivastigmine",null,null,null,"Cost-effectiveness,Cost-utility",null,"International",null,"Alzheimer’s","Donepezil,Galantamine,Rivastigmine","Cost-effectiveness,Cost-utility",null,null,"2000:2004"]
[115,"Wolfson C, Oremus M, Shukla V, Momoli F, Demers L, Perrault A, Moride Y. Donepezil and rivastigmine in the treatment of Alzheimer's disease: a best-evidence synthesis of the published data on their efficacy and cost-effectiveness. Clin Ther. 2002 Jun;24(6):862-86; discussion 837.",null,"Wolfson C, Oremus M, Shukla V, Momoli F, Demers L, Perrault A, Moride Y."," Donepezil and rivastigmine in the treatment of Alzheimer's disease: a best-evidence synthesis of the published data on their efficacy and cost-effectiveness.","Various drugs have been approved for the treatment of Alzheimer's disease (AD) in the United States and Canada, including donepezil and rivastigmine, although questions remain as to their efficacy, effectiveness, and long-term benefits. The goal of this study was to conduct a best-evidence synthesis of data on the efficacy and cost-effectiveness of donepezil and rivastigmine in the treatment of AD. Relevant published randomized controlled trials (RCTs) and Phase IV open-label extension studies (excluding abstracts) were identified through searches of MEDLINE, HealthSTAR, and PsycINFO for the period January 1984 to October 2001. The bibliographies of retrieved articles were searched for additional publications. For inclusion in the best-evidence synthesis, clinical trials had to pass a blinded quality assessment (score > or =5 on the Jadad scale) and use National Institute of Neurological and Communicative Disease and Stroke-Alzheimer's Disease and Related Disorders Association diagnostic criteria. Economic studies were selected using National Health Service Centre for Reviews and Dissemination criteria for reporting critical summaries of economic evaluations. Nine RCTs of donepezil and 2 of rivastigmine were identified and met inclusion criteria for the best-evidence synthesis. Eight donepezil trials and both rivastigmine trials included patients with mild AD (Mini-Mental State Examination [MMSE] score, 15-27) or moderate AD (MMSE score, 8-14); 1 donepezil trial included patients with moderate or severe AD (MMSE score, 0-7). In the RCTs of donepezil, the mean decrease in scores on the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) was greater with active treatment than with placebo (lower scores indicate less cognitive deterioration). In the RCTs of rivastigmine, ADAS-cog scores decreased over the follow-up period with both active treatment and placebo; however, scores decreased more with active treatment. Three Phase IV studies of donepezil and I Phase IV study of rivastigmine were identified. Their results were consistent with those of the RCTs. Ten economic studies (7 donepezil, 3 rivastigmine) were identified and reviewed. In 4 of the donepezil studies and all 3 rivastigmine studies, use of the drug cost less than a no-drug strategy. The efficacy data indicate that both donepezil and rivastigmine can delay cognitive impairment and deterioration in global health for at least 6 months in patients with mild to moderate AD. Patients receiving active treatment will have more favorable ADAS-cog scores for at least 6 months, after which their scores will begin to converge with those of patients receiving placebo. Differences in methodology, types of direct or indirect costs included, and sources of cost data made it difficult to compare and synthesize findings of the economic studies; therefore, the cost-effectiveness data are inconclusive."," Clin Ther. 2002 Jun;24(6):862-86; discussion 837.","International",2002,"Alzheimer’s","Donepezil,Rivastigmine",null,null,null,"Unclear",null,"International",null,"Alzheimer’s","Donepezil,Rivastigmine","Unclear",null,null,"2000:2004"]
[116,"Lamb HM, Goa KL. Rivastigmine.  A pharmacoeconomic review of its use in Alzheimer's disease. Pharmacoeconomics. 2001;19(3):303-18.",null,"Lamb HM, Goa KL."," Rivastigmine.  A pharmacoeconomic review of its use in Alzheimer's disease. ","Alzheimer's disease is associated with a large cost burden, of which institutionalised care constitutes a major component. Therefore, the decision to move a patient from the community to institutionalised care is associated with a significant increase in direct costs. About three-quarters of patients with Alzheimer's disease are admitted to a nursing home within 5 years of diagnosis. Unpaid or informal caregiver time is another large cost in Alzheimer's disease, especially for patients cared for in the community; informal care can account for up to three-quarters of healthcare costs in non-institutionalised patients. Several cholinesterase inhibitors, of which rivastigmine is one, are available for the treatment of patients with mild to moderate Alzheimer's disease. By improving cognitive function and slowing the rate of cognitive decline, cholinesterase inhibitor therapy may reduce a significant part of the economic burden of the disease by delaying the move to institutionalised care. In the absence of prospective long term data which focus on pharmacoeconomic end-points, modelling techniques have been used to extrapolate clinical data available for some cholinesterase inhibitors, including rivastigmine. Four economic analyses, based on a single model of cognitive decline, have been performed with rivastigmine from the perspective of the provider or society. All show that rivastigmine therapy (excluding drug-related costs) is associated with cost savings in patients with mild to moderate Alzheimer's disease by delaying the time to institutionalisation. If the acquisition cost of the drug was factored in, the cost savings completely or partially offset treatment costs. The magnitude of the cost savings increased as the time horizon increased (up to 2 years). The largest savings were realised in patients with mild disease over a 2-year time-frame, suggesting that treatment should be initiated early from an economic viewpoint. Pharmacoeonomic data comparing different cholinesterase inhibitors are, as yet, unavailable. Pharmacoeconomic analyses, based on modelled data excluding drug costs, indicate that rivastigmine completely or partially offsets the costs of treatment by delaying cognitive decline and the time to institutionalisation in patients with mild to moderate Alzheimer's disease. From a societal perspective, cost savings are realised if the drug is introduced early in the disease. Additional benefits offered by rivastigmine on behavioural symptoms, which may reduce caregiver burden, have yet to be investigated from a pharmacoeconomic perspective.","Pharmacoeconomics. 2001;19(3):303-18.","International",2001,"Alzheimer’s","Rivastigmine",null,null,null,"Unclear",null,"International",null,"Alzheimer’s","Rivastigmine","Unclear",null,null,"2000:2004"]
[117,"Clegg A, Bryant J, Nicholson T, McIntyre L, De Broe S, Gerard K, Waugh N. Clinical and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer's disease: a rapid and systematic review. Health Technol Assess. 2001;5(1):1-137. ",null,"Clegg A, Bryant J, Nicholson T, McIntyre L, De Broe S, Gerard K, Waugh N."," Clinical and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer's disease: a rapid and systematic review.","Alzheimer's disease is the most common cause of dementia and is characterised by an insidious onset and slow deterioration. The estimated prevalence of Alzheimer's disease for a standard health authority (500,000 people) is about 3330. Current service involves a wide range of agencies, and drug therapy for some patients. To provide a rapid and systematic review of the clinical effectiveness and cost-effectiveness of donepezil, rivastigmine and galantamine in the symptomatic treatment of people suffering from Alzheimer's disease. A systematic review of the literature was undertaken. METHODS - DATA SOURCES: Searches were made of electronic databases, including MEDLINE, EMBASE, The Cochrane Library, Database of Abstracts of Reviews of Effectiveness, NHS Economic Evaluation Database, National Research Register, Science Citation Index, BIOSIS, EconLit, MRC Trials database, Early Warning System, Current Controlled Trials, TOXLINE, Index of Scientific and Technical Proceedings, and Getting Easier Access to Reviews. All sources were searched over the period covered by the databases up to March/July 2000. Bibliographies of related papers were assessed for relevant studies and experts were contacted for advice and peer review, and to identify additional published and unpublished references. Manufacturer submissions to the National Institute for Clinical Excellence (NICE) were reviewed. Studies were included if they fulfilled the following criteria: (1) INTERVENTION: donepezil, rivastigmine or galantamine used to treat Alzheimer's disease. (2) PARTICIPANTS: people diagnosed with Alzheimer's disease who meet the criteria for treatment with donepezil, rivastigmine and galantamine. (3) OUTCOMES: measures assessing changes in cognition, function, behaviour and mood, quality of life (including studies assessing carer well-being and carer-input), and time to institutionalisation. (4) DESIGN: systematic reviews of randomised controlled trials (RCTs) and RCTs comparing donepezil, rivastigmine or galantamine with placebo or each other or non-drug comparators were included in the review of effectiveness. Economic studies of donepezil, rivastigmine or galantamine used to treat Alzheimer's disease that included a comparator (or placebo) and both the costs and consequence (outcomes) of treatment were included in the review of cost-effectiveness. Studies in non-English language, and abstracts and conference poster presentations of systematic reviews, RCTs and economic evaluations were excluded. Two reviewers identified studies by independently screening study titles and abstracts, and then by examining the full text of selected studies to decide inclusion. METHODS - DATA EXTRACTION AND QUALITY ASSESSMENT: Data extraction and quality assessment were undertaken by one reviewer and checked by a second reviewer, with any disagreements resolved through discussion. The quality of RCTs was assessed using the Jadad scale and the quality of systematic reviews was assessed using criteria developed by the NHS Centre for Reviews and Dissemination. The quality of economic evaluation studies was assessed by their internal validity (i.e. the methods used) using a standard checklist, and external validity (i.e. the generalisability of the economic study to the population of interest) using a series of relevant questions. METHODS - DATA SYNTHESIS: The clinical effectiveness and cost-effectiveness of donepezil, rivastigmine and galantamine were synthesised through a narrative review with full tabulation of results of all included studies. In the economic evaluation, the reviewers assessed whether adjustments could be made to existing models to reflect the current situation in England and Wales. RESULTS - CLINICAL EFFECTIVENESS: (1) Donepezil--three systematic reviews and five RCTs (plus four studies from industry (unpublished data, submitted as commercial in confidence)) were found. Results suggest that donepezil is beneficial when assessed using global and cognitive outcome measures. (2) Rivastigmine--three systematic reviews and five RCTs (plus two studies from industry (unpublished data, submitted as commercial in confidence)) were found. Results suggest that rivastigmine is beneficial in terms of global outcome measures. (3) Galantamine--one systematic review and three RCTs (plus three studies from industry (unpublished data, submitted as commercial in confidence)) were found. Results suggest that galantamine is beneficial in terms of global, cognitive and functional scales. RESULTS - SUMMARY OF BENEFITS: It is difficult to quantify benefits from the evidence available in the literature. Statistically significant improvements in tests such as ADAS-cog (Alzheimer's Disease Assessment Scale cognitive subscale) may not be reflected in changes in daily life. (ABSTRACT TRUNCATED)"," Health Technol Assess. 2001;5(1):1-137. ","UK",2001,"Alzheimer’s","Donepezil,Galantamine,Rivastigmine",null,null,null,"Unclear",null,"UK",null,"Alzheimer’s","Donepezil,Galantamine,Rivastigmine","Unclear",null,null,"2000:2004"]
[118,"Foster GR, Scott DA, Payne S. The use of CT scanning in dementia.  A systematic review. Int J Technol Assess Health Care. 1999 Spring;15(2):406-23.",null,"Foster GR, Scott DA, Payne S."," The use of CT scanning in dementia.  A systematic review. ","While reversible cases of dementia are rare once detected, the patient may benefit from treatment. This paper examines the cost-effectiveness of computerized tomography (CT) scanning as a screening test for potentially reversible dementia. A systematic review was carried out to identify the proportion of patients with dementia above and below the age of 65 years with a theoretically treatable condition and the proportion of these patients who would benefit from neurosurgery. Information was combined with epidemiological and financial data relating to Scotland to model the costs and benefits of implementing a national screening program. Subdural hematoma, normal pressure hydrocephalus, and brain tumours are rare conditions treatable by neurosurgery. A scanning and treatment program for Scotland would cost 4.6 million Pounds per annum. Of 531 reversible cases detected, 136 would benefit from neurosurgery, 369 would not benefit, and 26 would die as a result of surgery. Treating normal pressure hydrocephalus reduces overall quality-adjusted survival. The most cost effective screening strategy is to scan all patients but treat only subdural hematomas, gaining 178 quality-adjusted life-years (QALYs) at a cost of 14,171 Pounds per QALY for patients aged 65 at the time of the scan. The corresponding figures for patients above and below 65 years are 9,000 Pounds and 23,000 Pounds, respectively. CT scanning appears cost-effective in dementia patients under 65 years. It should be undertaken selectively in more elderly patients. Surgical treatment of normal pressure hydrocephalus may reduce quality adjusted survival and should only be undertaken within clinical trials.","Int J Technol Assess Health Care. 1999 Spring;15(2):406-23.","UK",1999,null,"Diagnosis",null,null,null,"Cost-utility",null,"UK",null,null,"Diagnosis","Cost-utility",null,null,"1960:1999"]
[119,"Jönsson L, Lindgren P, Wimo A, Jönsson B, Winblad B. The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer's disease: a Markov model. Clin Ther. 1999 Jul;21(7):1230-40. ","doi: 10.1016/S0149-2918(00)80025-9. ","Jönsson L, Lindgren P, Wimo A, Jönsson B, Winblad B."," The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer's disease: a Markov model.","This study compared the cost-effectiveness of donepezil, a new cholinesterase inhibitor indicated for the treatment of mild-to-moderate probable Alzheimer's disease (AD), with no treatment. A Markov state transition model was employed to simulate treatment costs based on Swedish epidemiologic data. The Markov states used in the model were defined according to cognitive function, as assessed by the Mini-Mental State Examination. Data on costs and baseline transition probabilities were taken from the Kungsholmen Project, an observational, population-based study of persons aged >75 years in Sweden. Data on the treatment effect were taken from a clinical trial comparing donepezil to placebo over 24 weeks and were applied to the baseline transition probabilities to assess the effect of treating the clinical manifestations of AD in Swedish patients. Also, a within-trial analysis was performed for comparison, using transition probabilities taken from the clinical study. Both models were run for 5 years in half-year cycles, and both demonstrated various degrees of cost savings and improved effectiveness, as measured by increased time in nonsevere disease states. Thus donepezil had superior cost-effectiveness compared with no treatment."," Clin Ther. 1999 Jul;21(7):1230-40. ","Sweden",1999,"Alzheimer’s","Donepezil",null,null,null,"Unclear",null,"Sweden",null,"Alzheimer’s","Donepezil","Unclear",null,null,"1960:1999"]
[120,"Neumann PJ, Hermann RC, Kuntz KM, Araki SS, Duff SB, Leon J, Berenbaum PA, Goldman PA, Williams LW, Weinstein MC. Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease. Neurology. 1999 Apr 12;52(6):1138-45. ",null,"Neumann PJ, Hermann RC, Kuntz KM, Araki SS, Duff SB, Leon J, Berenbaum PA, Goldman PA, Williams LW, Weinstein MC."," Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease.","To demonstrate the use of cost-effectiveness analysis to assess the economic impact of donepezil in the treatment of mild or moderate AD. Cost-effectiveness analyses show the relationship between resources used (costs) and health benefits achieved (effects) for an intervention compared with an alternative strategy. We developed a model to estimate the incremental cost-effectiveness of donepezil compared with no treatment. We determined costs per quality-adjusted life-years gained, a measurement that enhances the comparability of diverse studies. The model projects the progression of AD patients into more severe disease stages and into nursing homes. Data from a randomized clinical trial of donepezil were used to assess the drug's impact on the 6-week probabilities of progression. Data on the costs and health-related quality of life associated with different disease stages and settings were taken from published estimates and our companion cross-sectional study, respectively. Donepezil costs are partially offset by a reduction in the costs of care due to enhancement in cognitive functioning and the delay to more costly disease stages and settings. The magnitude of this cost offset and of the effect of donepezil on health-related quality of life depends on the model's assumptions about the duration of the drug effect, where controlled data are lacking. If the drug effect exceeds 2 years, the model predicts that for mild AD the drug would pay for itself in terms of cost offsets. The results of the cost-effectiveness model presented here suggest that donepezil may be cost-effective but additional controlled data on long-term drug efficacy are needed."," Neurology. 1999 Apr 12;52(6):1138-45. ","USA",1999,"Alzheimer’s","Donepezil",null,null,null,"Cost-utility",null,"USA",null,"Alzheimer’s","Donepezil","Cost-utility",null,null,"1960:1999"]
[121,"Ernst RL, Hay JW. Economic research on Alzheimer disease: a review of the literature. Alzheimer Dis Assoc Disord. 1997;11 Suppl 6():135-45.",null,"Ernst RL, Hay JW."," Economic research on Alzheimer disease: a review of the literature.","The present review discusses the economic research to date on Alzheimer disease (AD). It focuses on estimates of the costs of AD and on economic evaluations of interventions in the disease. Empirical and conceptual issues concerning the interpretation of costs and the uses of evaluative methodologies also are discussed. We conclude that estimates of the national costs of AD are open to a large margin of uncertainty. We conclude further that significant opportunities exist for new cost-effectiveness or cost-benefit analyses of AD treatments, patient care options, and counselling, respite, or similar programs for AD caregivers."," Alzheimer Dis Assoc Disord. 1997;11 Suppl 6():135-45.","International",1997,"Alzheimer’s","None or unclear",null,null,null,"Unclear",null,"International",null,"Alzheimer’s","None or unclear","Unclear",null,null,"1960:1999"]
[122,"Wimo A, Mattsson B, Krakau I, Eriksson T, Nelvig A. Cost-effectiveness analysis of day care for patients with dementia disorders. Health Econ. 1994 Nov-Dec;3(6):395-404.",null,"Wimo A, Mattsson B, Krakau I, Eriksson T, Nelvig A."," Cost-effectiveness analysis of day care for patients with dementia disorders.","In a cost-effectiveness analysis, the costs of 55 demented patients in day care (DC) and 45 patients on a waiting list were related to the effects on indices measuring quality of life. Based on one year's study, the costs per patient per day, was USD 55 for the DC-group and USD 63 for the controls (p > 0.05). Both groups deteriorated in the indices during the study year. The trend was that DC was both cheaper and better in the indices, and some of the underlying variables for the used indices also showed significantly better results in favour of DC. However, since the changes between the groups were not significant regarding the basic question at issue, it cannot be stated that DC is more cost-effective than a care organisation without DC. Different interpretations of the results are presented."," Health Econ. 1994 Nov-Dec;3(6):395-404.","Sweden",1994,"Any dementia","Formal care",null,null,null,"Cost-utility",null,"Sweden",null,"Any dementia","Formal care","Cost-utility",null,null,"1960:1999"]
[123,"Neumann PJ, Hermann RC, Berenbaum PA, Weinstein MC. Methods of cost-effectiveness analysis in the assessment of new drugs for Alzheimer's disease. Psychiatr Serv. 1997 Nov;48(11):1440-4. ","doi: 10.1176/ps.48.11.1440.","Neumann PJ, Hermann RC, Berenbaum PA, Weinstein MC."," Methods of cost-effectiveness analysis in the assessment of new drugs for Alzheimer's disease.","New treatments for Alzheimer's disease highlight the complex clinical and financial issues at stake with new pharmacotherapies. This paper describes cost-effectiveness analysis as a method for assessing these issues. Cost-effectiveness analyses show the relationship between resources used and health benefits achieved for a medical intervention compared with an alternative strategy. In analyses of treatments of Alzheimer's disease, costs include health care resources, such as diagnostic tests, medications and efforts to monitor or treat side effects, acute hospital care, physicians' services, home health care, and nursing home care; non-health-care resources, such as support services provided by paid caregivers; and time spent by family members in unpaid provision of care and by patients in seeking care or undergoing an intervention. Effectiveness of interventions can be assessed by measuring changes in patients' cognitive functioning or by measuring years of life gained and the quality of life during those years. Cost-effectiveness studies often make use of disparate data sources, including data collected as part of randomized controlled clinical trials, and they often use mathematical models to support estimates. Because economic evaluations of new interventions for Alzheimer's disease will likely play an increasingly influential role in clinical and resource allocation in the coming years, physicians and other health system stakeholders should familiarize themselves with the techniques of cost-effectiveness analysis and become critical consumers of the literature describing these analyses."," Psychiatr Serv. 1997 Nov;48(11):1440-4. ","International",1997,"Alzheimer’s","None or unclear",null,null,null,"Unclear",null,"International",null,"Alzheimer’s","None or unclear","Unclear",null,null,"1960:1999"]
[124,"Retchin SM, Hillner BE. The costs and benefits of a screening program to detect dementia in older drivers. Med Decis Making. 1994 Oct-Dec;14(4):315-24.",null,"Retchin SM, Hillner BE."," The costs and benefits of a screening program to detect dementia in older drivers.","A Markov model was used to assess the cost-benefit ratios of six strategies of screening older drivers for mental status, beginning at age 65. Probabilities of motor vehicle collisions (MVCs), injuries, and fatalities were obtained from national data. Dementia prevalence, test characteristics, and costs were obtained from the literature. Costs included lost wages, car ownership, alternative transportation, and injuries. Using a relative risk of MVC for those with dementia of 5 and a 5% annual discounting rate, the average cost per driver ranged from $51,600 (no testing) to $58,400 (testing every five years). The benefit was < one day of life gained, and the benefits of screening cost approximately 2.8 million dollars per life-year gained. Increasing the relative risk from 5 to 20 substantially improved the cost-benefit of mental status screening. However, mental status screening of older drivers would also be cost-beneficial if physician referral costs were lowered to $60 per evaluation. The authors conclude that a dementia screening program for older drivers would be cost-beneficial if physician evaluations were limited or their cost lowered to < or = $60."," Med Decis Making. 1994 Oct-Dec;14(4):315-24.","USA",1994,"Any dementia","Diagnosis",null,null,null,"Cost-effectiveness",null,"USA",null,"Any dementia","Diagnosis","Cost-effectiveness",null,null,"1960:1999"]
[125,"Wimo A, Mattson B, Krakau I, Eriksson T, Nelvig A, Karlsson G. Cost-utility analysis of group living in dementia care. Int J Technol Assess Health Care. 1995 Winter;11(1):49-65. ",null,"Wimo A, Mattson B, Krakau I, Eriksson T, Nelvig A, Karlsson G."," Cost-utility analysis of group living in dementia care.","A cost-utility analysis (CUA) was applied to group living for dementia patients. A Markov-model of an expected life-length of 8 years was used. Forty-six patients in group living were compared to 39 patients living at home by inclusion and 23 institutionalized patients. When the cost per gained quality-adjusted life-year (QALY) was calculated, the group living alternative was the most favorable for the patients, giving a cost per paired QALY of US dollars < 0. In the extensive sensitivity analysis the main result was consistent but methodological problems were indicated."," Int J Technol Assess Health Care. 1995 Winter;11(1):49-65. ","USA",1995,"Any dementia","Formal care",null,null,null,"Cost-utility",null,"USA",null,"Any dementia","Formal care","Cost-utility",null,null,"1960:1999"]
[126,"Weinberger DR. Brain disease and psychiatric illness: when should a psychiatrist order a CAT scan? Am J Psychiatry. 1984 Dec;141(12):1521-7. ","doi: 10.1176/ajp.141.12.1521.","Weinberger DR."," Brain disease and psychiatric illness: when should a psychiatrist order a CAT scan? Am J Psychiatry.","Because psychiatric symptoms are frequently the earliest signs of CNS pathology, the author outlines the structural brain diseases that may underlie several psychiatric syndromes and describes the computerized axial tomographic (CAT) scan findings associated with those diseases. On the basis of an awareness of these conditions and a cost-benefit analysis, the following indications for CAT scanning of psychiatric patients are proposed: 1) confusion and/or dementia of unknown cause, 2) first episode of a psychosis of unknown etiology, 3) movement disorder of unknown etiology, 4) anorexia nervosa, 5) prolonged catatonia, and 6) first episode of major affective disorder or personality change after age 50."," 1984 Dec;141(12):1521-7. ","Unknown",1984,"Any dementia","Diagnosis",null,null,null,"Cost-benefit",null,"Unknown",null,"Any dementia","Diagnosis","Cost-benefit",null,null,"1960:1999"]
[127,"Engedal K. Day care for demented patients in general nursing homes.  Effects on admissions to institutions and mental capacity. Scand J Prim Health Care. 1989 Oct;7(3):161-6. ",null,"Engedal K."," Day care for demented patients in general nursing homes.  Effects on admissions to institutions and mental capacity. ","A day centre programme for demented patients aged 75 years and over was evaluated in a controlled trial, emphasizing its effect on the use of institutional care and mental capacity. A cost-benefit analysis of the programme was also performed. Thirty-eight patients were offered day care, thirty-nine served as controls. The programme was cost-effective in the sense that it reduced the frequency of the admissions to the acute units of the City hospitals and the cost of care. However, admission to permanent stay in nursing home was not delayed. The mental capacity deteriorated at the same rate in the two groups.","Scand J Prim Health Care. 1989 Oct;7(3):161-6. ","Unknown",1989,"Any dementia","Formal care",null,null,null,"Unclear",null,"Unknown",null,"Any dementia","Formal care","Unclear",null,null,"1960:1999"]
[128,"Geldmacher DS. The cost benefit to health plans of pharmacotherapy for Alzheimer's disease. Manag Care. 2005 Dec;14(12):44-6, 49-52, 54-5. d",null,"Geldmacher DS."," The cost benefit to health plans of pharmacotherapy for Alzheimer's disease.","Treatment of Alzheimer's disease (AD) is a major public health issue, with the potential for significant impact on MCOs. As the number of people affected with AD continues to rise, the importance of this problem will grow as well. This article reviews patient and caregiver outcomes associated with reduced health care costs and their implications for MCOs. Cholinesterase inhibitors (ChEIs) are effective in treating cognitive, functional, and behavioral symptoms for patients with mild to moderate and moderate to severe AD. Treatment with memantine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to benefit patients with moderate to severe AD. Pharmacoeconomic studies indicate that donepezil and memantine treatment may reduce total costs of care for AD patients and their caregivers, with potential economic benefits to MCOs."," Manag Care. 2005 Dec;14(12):44-6, 49-52, 54-5. d","International",2005,"Alzheimer’s","Any anticholinesterase,Donepezil,Memantine",null,null,null,"Unclear",null,"International",null,"Alzheimer’s","Any anticholinesterase,Donepezil,Memantine","Unclear",null,null,"2005:2009"]
[129,"McMahon PM, Araki SS, Neumann PJ, Harris GJ, Gazelle GS. Cost-effectiveness of functional imaging tests in the diagnosis of Alzheimer disease. Radiology. 2000 Oct;217(1):58-68. ","doi: 10.1148/radiology.217.1.r00se1358.","McMahon PM, Araki SS, Neumann PJ, Harris GJ, Gazelle GS."," Cost-effectiveness of functional imaging tests in the diagnosis of Alzheimer disease.","To evaluate the cost-effectiveness of functional neuroimaging in the work-up of patients at specialized Alzheimer disease clinics. A decision model was used to calculate costs and benefits (in quality-adjusted life-years [QALYs]) that accrued to hypothetical cohorts of patients at presentation to an Alzheimer disease center. Sensitivity analysis was performed to examine the effects of diagnostic test characteristics, therapeutic efficacy, disease severity, and costs on cost-effectiveness. The incremental cost-effectiveness ratio of dynamic susceptibility contrast material-enhanced magnetic resonance (MR) imaging was $479,500 per QALY (compared with the usual diagnostic work-up), while visual or quantitative single photon emission computed tomography (SPECT) was dominated (higher costs, lower effectiveness) by the usual diagnostic work-up. These results depend critically on the sensitivity and specificity of the standard diagnostic work-up, the effectiveness of drug treatment, and the disease severity. Varying these parameters resulted in estimates of incremental cost-effectiveness for dynamic susceptibility contrast-enhanced MR imaging of $24,680 to $8.6 million per QALY. SPECT either was dominated by the usual diagnostic work-up or had cost-effectiveness ratios of $180,200 to $6 million per QALY. The addition of functional neuroimaging to the usual diagnostic regimen at Alzheimer disease clinics is not cost-effective given the effectiveness of currently available therapies."," Radiology. 2000 Oct;217(1):58-68. ","USA",2000,"Alzheimer’s","Diagnosis",null,null,null,"Cost-utility",null,"USA",null,"Alzheimer’s","Diagnosis","Cost-utility",null,null,"2000:2004"]
[130,"Busschbach JJ, Brouwer WB, van der Donk A, Passchier J, Rutten FF. An outline for a cost-effectiveness analysis of a drug for patients with Alzheimer's disease. Pharmacoeconomics. 1998 Jan;13(1 Pt 1):21-34",null,"Busschbach JJ, Brouwer WB, van der Donk A, Passchier J, Rutten FF."," An outline for a cost-effectiveness analysis of a drug for patients with Alzheimer's disease.","This article provides an outline for a cost-effectiveness analysis of a drug that slows the consequences of Alzheimer's disease. Such an analysis cannot easily be performed for 2 main reasons. The first is that often relatives and friends, rather than professionals, take care of the patient. This means that informal care plays an important role in the analysis. However, consensus on how to value informal care is lacking. In this article, we have recommended the shadow-price method because this is an option that can be practically applied. The second reason is that the primary source of information on quality of life, the patients themselves, is unreliable because of cognitive disturbances. The solution is to ask 'significant others' to indicate quality of life instead of the patient. As well as measuring the patient's quality of life, the quality of life of the informal caregiver is also often measured. This is recommended here, but as a separate item in the analysis. In this way, double-counting in the final cost-effectiveness ratio can be avoided. Several instruments for measuring a patient's and caregiver's quality of life are discussed and recommendations about suitable methods are made."," Pharmacoeconomics. 1998 Jan;13(1 Pt 1):21-34","Netherlands",1998,"Alzheimer’s","None or unclear",null,null,null,"Cost-utility",null,"Netherlands",null,"Alzheimer’s","None or unclear","Cost-utility",null,null,"1960:1999"]
[131,"Vlietinck R, Van Loon H, Van de Broele H, Tormans G. Retrospective estimate of the nursing cost of autonomy impairment and cost benefit in clinical trials: feasibility and application of piracetam in demented elderly patients. Adv Ther. 1993 Sep-Oct;10(5):226-44.",null,"Vlietinck R, Van Loon H, Van de Broele H, Tormans G."," Retrospective estimate of the nursing cost of autonomy impairment and cost benefit in clinical trials: feasibility and application of piracetam in demented elderly patients.","The aims of this study were to determine whether the nursing costs of functional disability could be assessed retrospectively and, if so, whether this method was sensitive enough to show the influence of a treatment on economic costs. Four studies were available for this purpose: three randomized, double-blind, placebo-controlled, clinical trials measuring, among others, the influence of piracetam on activities of daily living (ADL) of elderly demented patients in Italy, Austria, and Belgium, and one large population-based survey measuring the costs of providing basic nursing, hygienic, and therapeutic needs to 6000 elderly according to ADL scores. The items on the different ADL scales used in each trial were recoded to a common denominator, and an overall dependency score was calculated for each patient. The survey data showed a highly significant linear correlation between ADL status and nursing expenses. Nursing costs of noninstitutionalized patients were calculated by assigning each patient the average nursing cost of all persons from the survey who matched by sex, age, and dependency score. Retrospective economic assessment was possible for ambulatory patients when there were functional assessments and a survey with nursing costs gauged according to those functional assessments. Objective classification criteria for hospital or retirement home patients are needed for the level of reimbursement of nursing costs. Piracetam treatment decreased dependency, compared with placebo. The economic improvement continued over the entire duration of all three clinical trials, lasting up to 6 months in the Italian trial in both ambulatory and residential settings. The decrease in nursing costs remained stable during the same period for patients treated with piracetam, whereas nursing costs of placebo patients steadily increased. After 6 months this difference increased a monthly average of 820 Belgian francs (BF {35 BF = 1 US $}) for ambulatory patients in favor of piracetam, 1650 BF for residential patients, and 2580 BF for hospitalized individuals."," Adv Ther. 1993 Sep-Oct;10(5):226-44.","Belgium",1993,"Any dementia","Formal care",null,null,null,"Cost-benefit",null,"Belgium",null,"Any dementia","Formal care","Cost-benefit",null,null,"1960:1999"]

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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SelectedYear","v":2016}]
[null,null,{"$f":"SelectedTitle","v":"Woods RT,Orrell M,Bruce E,Edwards RT,Hoare Z,Hounsome B,Keady J,Moniz-Cook E,Orgeta V,Rees J,Russell I."}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,6,0,null,null,null,null,null,null,1]
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[null,null,"PMID",null,null,{"$f":"SelectedPMID","v":"Any dementia"},null,null,null,null,null,"DOI",null,{"$f":"SelectedDOI","v":"Other psychological therapies"}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[null,null,"Locations",null,null,null,null,null,null,"UK",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[null,null,"Interventions",null,null,null,null,null,null,"Other psychological therapies,",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[null,null,"Diseases",null,null,null,null,null,null,"Any dementia",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null," ",null,null," "]
[null,null,"PRO tools"]
[null,null,"Sub-populations"]
[null,null,"Study types",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[null,null,"Study methodologies"]
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[null,"Toggle age cut-offs",null,null,null,null,null,null,6,1,null,null,null,null,null,null,null,null,null,1,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"This year =",{"$f":"YEAR(NOW())","v":2018},null,"Years","Cut","Selected cut state","Start","End",{"$f":"COUNTA(CF3:CF58)","v":5},{"$f":"OFFSET($CI$2,0,domainChoice)","v":"Study types"},"Locations","Interventions","Diseases","PRO tools","subPopulations","Study types","Study methodologies",null,null,null,null,"selected categories"]
[null,null,56,null,null,null,null,null,"Other","Cost-benefit",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1960,false,true,1960,1999,{"$f":"IF(CF3<>\"\",_xlfn.CONCAT(CF3,\":\",CG3),\"\")","v":"1960:1999"},{"$f":"OFFSET($CJ$2,0,ROW()-3)","v":"Locations"},"Australia","Antidepressants","Alzheimer’s",null,null,"Cost-benefit",null,null,null,null,null,{"$f":"OFFSET(INDIRECT($CU$1),ROW()-3,0)","v":"Other"}]
[null,"From",null,null,"To",null,null,null,null,"Cost-benefit",null,null,null,null,null,null,null,null,null,null,null,"C1",null,"Locations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OFFSET($BY$5,domainChoice,0)","v":"studytypeCategories"},null,null,null,1961,false,null,2000,2004,{"$f":"IF(CF4<>\"\",_xlfn.CONCAT(CF4,\":\",CG4),\"\")","v":"2000:2004"},{"$f":"OFFSET($CJ$2,0,ROW()-3)","v":"Interventions"},"Belgium","Antipsychotics","Any dementia",null,null,"Cost-effectiveness",null,null,null,null,null,{"$f":"OFFSET(INDIRECT($CU$1),ROW()-3,0)","v":"Cost-benefit"}]
[null,{"$f":"IF(CF3=\"\",\"\",CF3)","v":1960},null,null,{"$f":"IF(CG3=\"\",\"\",CG3)","v":1999},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C2",null,"Interventions",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1962,false,"Segment count",2005,2009,"2005:2009","Diseases","Canada","Any anticholinesterase","CJD",null,null,"Cost-utility",null,null,null,null,null,"Cost-effectiveness"]
[null,{"$f":"IF(CF4=\"\",\"\",CF4)","v":2000},null,null,{"$f":"IF(CG4=\"\",\"\",CG4)","v":2004},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C3",null,"Diseases",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"locationCategories",null,null,null,1963,false,null,2010,2014,"2010:2014","PRO tools","Finland","Behavioural therapies","Lewy body dementia",null,null,"Unclear",null,null,null,null,null,"Cost-utility"]
[null,2005,null,null,2009,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C4",null,"Sub-populations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"interventionCategories",null,null,null,1964,false,null,2015,2017,"2015:2017","subPopulations","France","Caregiver support","Parkinson’s dementia",null,null,null,null,null,null,null,null,"Unclear"]
[null,2010,null,null,2014,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C5",null,"PRO tools",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"diseaseCategories",null,null,null,1965,false,null,null,null,"","Study types","Germany","Cognitive therapies","Vascular dementia",null,null,null,null,null,null,null,null,""]
[null,2015,null,null,2017,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study types",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"protoolCategories",null,null,null,1966,false,null,null,null,"","Study methodologies","Indonesia","Deep brain stimulation",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study methodologies",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"subpopulationCategories",null,null,null,1967,false,null,null,null,"",null,"International","Diagnosis",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Location categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"studytypeCategories",null,null,null,1968,false,null,null,null,"",null,"Ireland","Diet",null,null,null,null,null,null,null,null,null,""]
[null,{"$f":"IF(CF10=\"\",\"\",CF10)","v":""},null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Intervention categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"studymethodCategories",null,null,null,1969,false,null,null,null,"",null,"Korea","Disease management",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Disease categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1970,false,null,null,null,"",null,"Netherlands","Donepezil",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sub-populations categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1971,false,null,null,null,"",null,"Norway","Exercise",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PRO tool categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1972,false,null,null,null,"",null,"Spain","Formal care",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,{"$f":"IF(CG14=\"\",\"\",CG14)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study type categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1973,false,null,null,null,"",null,"Sweden","Galantamine",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study methodology categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1974,false,null,null,null,"",{"$f":"COLUMN()","v":87},"Switzerland","Informal care",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1975,false,null,null,null,"",null,"Taiwan","Memantine",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1976,false,null,null,null,"",null,"UK","Memory clinic",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1977,false,null,null,null,"",null,"USA","None or unclear",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1978,false,null,null,null,"",null,"Unknown","Occupational therapy",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1979,false,null,null,null,"",null,null,"Other psychological therapies",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1980,false,null,null,null,"",null,null,"Prevention",null,null,null,null,null,null,null,null,null,""]
[null,"",22,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1981,false,null,null,null,"",null,null,"Rivastigmine",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1982,false,null,null,null,"",null,null,"Support",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1983,false,null,null,null,"",null,null,"Telecare",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1984,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1985,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1986,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1987,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1988,false,null,null,null,{"$f":"IF(CF31<>\"\",_xlfn.CONCAT(CF31,\":\",CG31),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1989,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1990,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1991,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1992,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1993,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1994,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1995,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1996,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1997,false,null,null,null,{"$f":"IF(CF40<>\"\",_xlfn.CONCAT(CF40,\":\",CG40),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1998,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1999,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000,true,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2001,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2002,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2003,false,null,null,null,{"$f":"IF(CF46<>\"\",_xlfn.CONCAT(CF46,\":\",CG46),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,""]
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