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

• Published in: The Journal of nutrition, health & aging health & aging, 2009-03, Vol.13 (3), p.242-248
• Main Authors: Meeuwsen, Els J., Melis, R. J. F., Adang, E. M., Golüke-Willemse, G. A., Krabbe, P. F., De Leest, B. J., Van Raak, F. H. J. M., Schölzel-Dorenbos, C. J. M., Visser, M. C., Wolfs, C. A., Vliek, S., Olde Rikkert, M. G. M.
• Format: Article
• Language: English
• Subjects: AD-Euro Study; Aging; Biological and medical sciences; Caregivers; Community Health Centers - economics; Continuity of Patient Care; Cost-Benefit Analysis; Dementia; Dementia - economics; Dementia - therapy; Europe; Family Practice - economics; Family Practice - methods; Feeding. Feeding behavior; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Geriatrics/Gerontology; Health Services Research; Humans; Medicine; Medicine & Public Health; Neurosciences; Nutrition; Outcome and Process Assessment, Health Care; Primary Care Medicine; Primary Health Care - economics; Primary Health Care - methods; Quality of Life; Quality of Life Research; Research Design; Surveys and Questionnaires; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 1279-7707; 1760-4788
• DOI: 10.1007/s12603-009-0066-1

Background 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. Objective 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. Method 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. Results 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. Discussion 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. Trial registration ClinicalTrials.gov Identifier NCT00554047