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Who Benefits Most from Collaborative Dementia Care from a Patient and Payer Perspective? A Subgroup Cost-Effectiveness Analysis.

Published on Jan 1, 2020in Journal of Alzheimer's Disease3.517
· DOI :10.3233/JAD-190578
Anika Rädke (German Center for Neurodegenerative Diseases), Bernhard Michalowsky14
Estimated H-index: 14
(German Center for Neurodegenerative Diseases)
+ 3 AuthorsWolfgang Hoffmann17
Estimated H-index: 17
(German Center for Neurodegenerative Diseases)
Abstract
BACKGROUND: Dementia care management (DCM) aims to provide optimal treatment for people with dementia (PwD). Treatment and care needs are dependent on patients' sociodemographic and clinical characteristics and thus, economic outcomes could depend on such characteristics. OBJECTIVE: To detect important subgroups that benefit most from DCM and for which a significant effect on cost, QALY, and the individual cost-effectiveness could be achieved. METHODS: The analysis was based on 444 participants of the DelpHi-trial. For each subgroup, the probability of DCM being cost-effective was calculated and visualized using cost-effectiveness acceptability curves. The impact of DCM on individual costs and QALYs was assessed by using multivariate regression models with interaction terms. RESULTS: The probability of DCM being cost-effective at a willingness-to-pay of 40,000euro /QALY was higher in females (96% versus 16% for males), in those living alone (96% versus 26% for those living not alone), in those being moderately to severely cognitively (100% versus 3% for patients without cognitive impairment) and functionally impaired (97% versus 16% for patients without functional impairment), and in PwD having a high comorbidity (96% versus 26% for patients with a low comorbidity). Multivariate analyses revealed that females (b = -10,873; SE = 4,775, p = 0.023) who received the intervention had significantly lower healthcare cost. DCM significantly improved QALY for PwD with mild and moderate cognitive (b = +0.232, SE = 0.105) and functional deficits (b = +0.200, SE = 0.095). CONCLUSION: Patients characteristics significantly affect the cost-effectiveness. Females, patients living alone, and those being moderately cognitively and functionally impaired benefit most from DCM. For those subgroups, healthcare payers could gain the highest cost savings and the highest effects on QALYs when DCM will be implemented.
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References63
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#1Bernhard Michalowsky (McMaster University)H-Index: 1
#2Feng Xie (McMaster University)H-Index: 1
Last. Wolfgang Hoffmann (German Center for Neurodegenerative Diseases)H-Index: 17
view all 11 authors...
Abstract Introduction The purpose of this study was to determine the cost-effectiveness of collaborative dementia care management (DCM). Methods The cost-effectiveness analysis was based on the data of 444 patients of a cluster-randomized, controlled trial, conceptualized to evaluate a collaborative DCM that aimed to optimize treatment and care in dementia. Health-care resource use, costs, quality-adjusted life years (QALYs), and incremental cost per QALY gained were measured over a 24-month tim...
2 CitationsSource
#1Anika Kaczynski (German Center for Neurodegenerative Diseases)H-Index: 6
#2Bernhard Michalowsky (German Center for Neurodegenerative Diseases)H-Index: 14
Last. Wolfgang Hoffmann (German Center for Neurodegenerative Diseases)H-Index: 17
view all 7 authors...
BACKGROUND: People with dementia (PwD) suffer from coexisting medical conditions, creating complex clinical challenges and increasing the risk of poor outcomes, which could be associated with high healthcare cost. OBJECTIVE: To describe the prevalence of comorbidity in PwD and to analyze the association between comorbidity in dementia diseases and healthcare costs from a payer's perspective. METHODS: This cross-sectional analysis was based on n = 362 PwD of the DelpHi-MV trial (Dementia: Life-an...
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Abstract The objectives of this cross-sectional analysis were to determine healthcare resource utilization and cost for community-dwelling patients with dementia (PWD) from a payer’s and societal perspective, and to analyze the associations between costs and sociodemographic and clinical variables. Analysis of healthcare costs from a payer’s perspective was based on a sample of 425 PWD, analysis of healthcare costs from societal perspective on a subsample of 254 PWD and their informal caregivers...
11 CitationsSource
#1Jochen René Thyrian (German Center for Neurodegenerative Diseases)H-Index: 23
#2Johannes Hertel (University of Greifswald)H-Index: 1
Last. Wolfgang Hoffmann (University of Greifswald)H-Index: 17
view all 10 authors...
Importance Dementia care management (DCM) can increase the quality of care for people with dementia. Methodologically rigorous clinical trials on DCM are lacking. Objective To test the effectiveness and safety of DCM in the treatment and care of people with dementia living at home and caregiver burden (when available). Design, Setting, and Participants This pragmatic, general practitioner–based, cluster-randomized intervention trial compared the intervention with care as usual at baseline and at...
20 CitationsSource
#1Jochen René Thyrian (German Center for Neurodegenerative Diseases)H-Index: 23
#2Tilly Eichler (German Center for Neurodegenerative Diseases)H-Index: 13
Last. WolfgangHoffmann (University of Greifswald)H-Index: 46
view all 9 authors...
Background: Efficient help and care for people with dementia (PWD) is dependent on knowledge about PWD in primary care. This analysis comprehensively describes community-dwelling PWD in primary care with respect to various dementia care specific variables. Methods: The analyses are based on baseline data of the ongoing general practitioner-based, randomized, controlled intervention trial DelpHi-MV (Dementia: life- and person-centered help). 6,838 patients were screened for dementia in 136 GP pra...
13 CitationsSource
#1Tilly Eichler (German Center for Neurodegenerative Diseases)H-Index: 13
#2Wolfgang Hoffmann (German Center for Neurodegenerative Diseases)H-Index: 17
Last. Jochen René Thyrian (German Center for Neurodegenerative Diseases)H-Index: 23
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Background: Little is known about the proportion and the characteristics of community-dwelling people with dementia (PWD) living alone in Germany. Objectives: To analyze the prevalence of PWD living alone (with and without the support of an informal caregiver) and socio-demographical and clinical characteristics as well as health and nursing care utilization associated with living alone. Methods: DelpHi-MV (Dementia: Life- and person-centered help in Mecklenburg-Western Pomerania) is a general p...
11 CitationsSource
lichen Neuregelungen des alten Heimrechts in immer mehr deutschen Bundeslandern verbessern sich die Bedingungen fur die Schaffung gemeinschaftlicher, kleiner Wohn- und Versorgungseinheiten, wie Wohngemeinschaften fur Menschen mit Demenz, und alternative Pflegesettings, die ihre konzeptionellen Vorbilder vielfach in den west- und nordeuropaischen Nachbarlandern haben. In vielen deutschen Kommunen entstehen derzeit Versorgungsnetzwerke, die unterschiedlich strukturiert und gesteuert werden, z. B. ...
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BackgroundThe prevalence of dementia is expected to soar as the average life expectancy increases, but recent estimates suggest that the age-specific incidence of dementia is declining in high-income countries. Temporal trends are best derived through continuous monitoring of a population over a long period with the use of consistent diagnostic criteria. We describe temporal trends in the incidence of dementia over three decades among participants in the Framingham Heart Study. MethodsParticipan...
326 CitationsSource
#1Adina Dreier (German Center for Neurodegenerative Diseases)H-Index: 13
#2Jochen René Thyrian (German Center for Neurodegenerative Diseases)H-Index: 23
Last. Wolfgang Hoffmann (German Center for Neurodegenerative Diseases)H-Index: 17
view all 4 authors...
Summary Background A substantial increase of people with dementia (PwD) is predicted for the future. Nurses are taking over important tasks to support PwD, which requires a specialized qualification. Objectives The aim was to identify points for revision and to further improve the Dementia Care Manager (DCM) curriculum as a basis for probable qualification of nurses caring for PwD. Design We conducted a summative evaluation study to revise the first version of the DCM curriculum. Setting The stu...
11 CitationsSource
#1Bernhard Michalowsky (German Center for Neurodegenerative Diseases)H-Index: 14
#2Jochen René Thyrian (German Center for Neurodegenerative Diseases)H-Index: 23
Last. Wolfgang Hoffmann (German Center for Neurodegenerative Diseases)H-Index: 17
view all 7 authors...
Background: The majority of people with dementia (PwD) live at home and require professional formal care and informal care that is generally provided by close relatives. Objective: To determine the utilization and costs of formal and informal care for PwD, indirect costs because of productivity losses of caregivers, and the associations between cost, socio-demographic and clinical variables. Methods: The analysis includes the data of 262 community-dwelling PwD and their caregivers. Socio-demogra...
10 CitationsSource
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