Cost-Effectiveness of Dementia Care Mapping in Care-Home Settings: Evaluation of a Randomised Controlled Trial

David M. Meads (), Adam Martin, Alys Griffiths, Rachael Kelley, Byron Creese, Louise Robinson, Joanne McDermid, Rebecca Walwyn, Clive Ballard and Claire A. Surr
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David M. Meads: University of Leeds
Adam Martin: University of Leeds
Alys Griffiths: Leeds Beckett University
Rachael Kelley: Leeds Beckett University
Byron Creese: University of Exeter
Louise Robinson: Newcastle University
Joanne McDermid: King’s College London
Rebecca Walwyn: University of Leeds
Clive Ballard: University of Exeter
Claire A. Surr: Leeds Beckett University

Applied Health Economics and Health Policy, 2020, vol. 18, issue 2, No 8, 237-247

Abstract: Abstract Background Behaviours such as agitation impact on the quality of life of care-home residents with dementia and increase healthcare use. Interventions to prevent these behaviours have little evidence supporting their effectiveness or cost-effectiveness. We conducted an economic evaluation alongside a trial assessing Dementia Care Mapping™ (DCM) versus usual care for reducing agitation, and highlight methodological challenges of conducting evaluations in this population and setting. Methods RCT data over 16 months from English care-home residents with dementia (intervention n = 418; control n = 308) were analysed. We conducted a cost-utility analysis from the healthcare provider perspective. We gathered resource use and utility (EQ-5D-5L and DEMQoL-Proxy-U) from people living with dementia and proxy informants (staff and relatives). Data were analysed using seemingly unrelated regression, accounting for care-home clustering and bootstrapping used to capture sampling uncertainty. Results Costs were higher in the intervention arm than in the control arm (incremental = £1479) due in part to high cost outliers. There were small QALY gains (incremental = 0.024) in favour of DCM. The base-case ICER (£64,380 per QALY) suggests DCM is not cost-effective versus usual care. With the exception of analyses excluding high cost outliers, which suggested a potential for DCM to be cost-effective, sensitivity analyses corroborated the base-case findings. Bootstrapped estimates suggested DCM had a low probability (

Date: 2020
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DOI: 10.1007/s40258-019-00531-1

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