63553
document
Early psychosocial intervention in Alzheimer 's disease : cost utility evaluation alongside the Danish Alzheimer 's Intervention Study ( DAISY ) . OBJECTIVE To assess the cost utility of early psychosocial intervention for patients with Alzheimer 's disease and their primary caregivers . DESIGN Cost utility evaluation alongside a multicentre , randomised controlled trial with 3 years of follow-up . SETTING Primary care and memory clinics in five Danish districts . PARTICIPANTS 330 community-dwelling patients and their primary caregivers . INTERVENTION Psychosocial counselling and support lasting 8-12 months after diagnosis and follow-up at 3 , 6 , 12 and 36 months in the intervention group or follow-up only in the control group . MAIN OUTCOME MEASURES The primary outcome measure was the cost of additional quality-adjusted life years ( QALYs ) . Costs were measured from a societal perspective , including the costs of healthcare , social care , informal care and production loss . QALYs were estimated separately for the patient and the caregiver before aggregation for the main analysis . RESULTS None of the observed cost and QALY measures were significantly different between the intervention and control groups , although a tendency was noted for psychosocial care leading to cost increases with informal care that was not outweighed by the tendency for cost savings with formal care . The probability of psychosocial intervention being cost-effective did not exceed 36 % for any threshold value . The alternative scenario analysis showed that the probability of cost-effectiveness increased over the range of threshold values used if the cost perspective was restricted to formal healthcare . CONCLUSIONS A multifaceted , psychosocial intervention programme was found unlikely to be cost-effective from a societal perspective . The recommendation for practice in settings that are similar to the Danish setting is to provide follow-up with referral to available local support programmes when needed , and to restrict large multifaceted intervention programmes to patients and caregivers with special needs until further evidence for cost-effectiveness emerges . TRIAL REGISTRATION The study was registered in the Clinical Trial Database as ISRCTN74848736 .
63554
Intervention_Physical
cost utility evaluation
63555
Intervention_Physical
cost utility
63556
Intervention_Physical
Cost utility
63557
Intervention_Psychological
Psychosocial counselling and support
63558
Intervention_Educational
follow-up
63559
Intervention_Control
control group
63560
Intervention_Control
control groups
63561
Outcome_Other
cost of additional quality-adjusted life years ( QALYs ) . Costs
63562
Outcome_Other
costs of healthcare
63563
Outcome_Other
social care
63564
Outcome_Other
informal care
63565
Outcome_Other
production loss
63566
Outcome_Other
QALYs
63567
Outcome_Other
cost
63568
Outcome_Other
QALY measures
63569
Outcome_Other
cost-effective
63570
Outcome_Other
probability of cost-effectiveness increased
63571
Outcome_Other
cost-effective
63572
Participant_Condition
Alzheimer 's disease :
63573
Participant_Condition
patients with Alzheimer 's disease and their primary caregivers
63574
Participant_Sample-size
330