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Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis

  • Martin Knapp (a1), Lene Thorgrimsen (a2), Anita Patel (a3), Aimee Spector (a2), Angela Hallam (a4), Bob Woods (a5) and Martin Orrell (a6)...
Abstract
Background

Psychological therapy groups for people with dementia are widely used, but their cost-effectiveness has not been explored.

Aims

To investigate the cost-effectiveness of an evidence-based cognitive stimulation therapy (CST) programme for people with dementia as part of a randomised controlled trial.

Method

A total of 91 people with dementia, living in care homes or the community, received a CST group intervention twice weekly for 8 weeks; 70 participants with dementia received treatment as usual. Service use was recorded 8 weeks before and during the 8-week intervention and costs were calculated. A cost-effectiveness analysis was conducted with cognition as the primary outcome, and quality of life as the secondary outcome. Cost-effectiveness acceptability curves were plotted.

Results

Cognitive stimulation therapy has benefits for cognition and quality of life in dementia, and costs were not different between the groups. Under reasonable assumptions, there is a high probability that CST is more cost-effective than treatment as usual, with regard to both outcome measures.

Conclusions

Cognitive stimulation therapy for people with dementia has effectiveness advantages over, and may be more cost-effective than, treatment as usual.

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Copyright
Corresponding author
Professor Martin Knapp, Personal Social Services Research Unit, London School of Economics, Houghton Street, London WC2A 2AE. Tel. +44 (0) 20 7955 6225; email: m.knapp@lse.ac.uk
Footnotes
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Declaration of interest

None.

Funding detailed in Acknowledgements.

Footnotes
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Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis

  • Martin Knapp (a1), Lene Thorgrimsen (a2), Anita Patel (a3), Aimee Spector (a2), Angela Hallam (a4), Bob Woods (a5) and Martin Orrell (a6)...
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eLetters

Cognitive stimulation therapy for people with dementia: cost effectiveness analysis

Sunny T Varghese, Resident
12 September 2006

Knapp et al (2006) have examined the cost effectiveness of Cognitive stimulation therapy in the treatment of dementia. The paper has lucidly explained the basics of cost effectiveness analysis (CEA) and has applied acceptability curves in the study, which made the paper interesting reading. Certain clarifications are required on the data presented in the study.

a) The authors have used very wide inclusion criteria of MMSE (range 10-24) which could have influenced the outcome. The cost may appear less and benefits would appear large for treatment with people who have milder problems.

b) The educational qualification of the patients has not been mentioned in the paper which would affect the outcome when MMSE is taken as the main outcome measure.

c) The cost effectiveness that has been proved in the study may disappear if the costs of training the personnel are taken into account.

d) Although the authors have mentioned that the cost of each session is £ 90 (£180 per week for two sessions for five patients)they have calculated the weekly rate per patient as £ 31.50. Further more the table 2 shows cost of intervention as £ 24.92, which needs more clarification.Itis also not mentioned by the authors as to why the costs have been inflated to 2001 rates.

e) In the outcome measure it is not clear why the authors have mentioned the change in ADAS- Cog score as -2.37 while in the initial study it is mentioned as +2.37 (Spector et al., 2003)

References

Knapp, M., Thorgrimsen, L., Patel, A., et al (2006) Cognitive stimulation therapy for people with dementia: cost effectiveness analysis.Br J Psychiatry, 188,574-580.

Spector, A.,Thorgrimsen, L.,Woods, B., et al (2003) Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. Br J Psychiatry, 183, 248-254.
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