Maintenance cognitive stimulation therapy: an economic evaluation within a randomized controlled trial

Francesco D'Amico; Amritpal Rehill; Martin Knapp; Elisa Aguirre; Helen Donovan; Zoe Hoare; Juanita Hoe; Ian Russell; Aimee Spector; Amy Streater; Christopher Whitaker; Robert T Woods; Martin Orrell

doi:10.1016/j.jamda.2014.10.020

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.

Authors

Affiliations

¹ Personal Social Services Research Unit, London School of Economics and Political Science, London, UK. Electronic address: damico@lse.ac.uk.
² Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
³ Dementia Care Research Centre, Research and Development Department, Maggie Lilley Suite, Goodmayes Hospital, North East London NHS Foundation Trust, Ilford, Essex, UK.
⁴ Clinical Psychology Service, South Essex Partnership NHS Foundation Trust, Healthlink, Bedford, UK.
⁵ North Wales Organisation for Randomised Trials in Health (NWORTH), Institute of Medical and Social Care Research, Bangor, Wales.
⁶ Division of Psychiatry, University College London, London, UK.
⁷ College of Medicine, Swansea University, Swansea, UK.
⁸ Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
⁹ DSDC Wales, Bangor University, Bangor, Gwynedd, Wales.

PMID: 25528281
DOI: 10.1016/j.jamda.2014.10.020

Abstract

Background: Cognitive Stimulation Therapy (CST) is effective and cost-effective for people with mild-to-moderate dementia when delivered biweekly over 7 weeks.

Aims: To examine whether longer-term (maintenance) CST is cost-effective when added to usual care.

Methods: 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.

Results: 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.

Conclusions: Continuation of CST is likely to be cost-effective for people with mild-to-moderate dementia.

Keywords: Cognitive stimulation therapy; acetylcholinesterase inhibitors; cost; cost-effectiveness; dementia; randomized controlled trial.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Aged
Aged, 80 and over
Cholinesterase Inhibitors / therapeutic use
Cognitive Behavioral Therapy / economics*
Cognitive Behavioral Therapy / methods*
Cost-Benefit Analysis
Dementia / drug therapy
Dementia / rehabilitation*
Female
Humans
Male
Neuropsychological Tests
Quality of Life
Single-Blind Method
Treatment Outcome

Substances

Cholinesterase Inhibitors

Associated data

ISRCTN/ISRCTN26286067