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Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study.
BMJ 2008; 336(7636):134-8BMJ

Abstract

OBJECTIVE

To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint.

DESIGN

Cost effectiveness study alongside a single blind randomised controlled trial.

SETTING

Memory clinic, day clinic of a geriatrics department, and participants' homes. Patients 135 patients aged > or =65 with mild to moderate dementia living in the community and their primary care givers.

INTERVENTION

10 sessions of occupational therapy over five weeks, including cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision.

MAIN OUTCOME MEASURES

Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment (that is, a combined patient and care giver outcome measure of clinically relevant improvement on process, performance, and competence scales) at three months after randomisation. Bootstrap methods used to determine confidence intervals for these measures.

RESULTS

The intervention cost 1183 euros (848 pounds sterling, $1738) (95% confidence interval 1128 euros (808 pounds sterling, $1657) to 1239 euros (888 pounds sterling, $1820)) per patient and primary care giver unit at three months. Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were 1748 euros (1279 pounds sterling, $2621) lower in the intervention group, with the main cost savings in informal care. There was a significant difference in proportions of successful treatments of 36% at three months. The number needed to treat for successful treatment at three months was 2.8 (2.7 to 2.9).

CONCLUSIONS

Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective, especially in terms of informal care giving.

Authors+Show Affiliations

Alzheimer Centre Nijmegen, Department of Occupational Therapy 897, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, Netherlands. m.graff@pmd.umcn.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18171718

Citation

Graff, Maud J L., et al. "Community Occupational Therapy for Older Patients With Dementia and Their Care Givers: Cost Effectiveness Study." BMJ (Clinical Research Ed.), vol. 336, no. 7636, 2008, pp. 134-8.
Graff MJ, Adang EM, Vernooij-Dassen MJ, et al. Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study. BMJ. 2008;336(7636):134-8.
Graff, M. J., Adang, E. M., Vernooij-Dassen, M. J., Dekker, J., Jönsson, L., Thijssen, M., ... Rikkert, M. G. (2008). Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study. BMJ (Clinical Research Ed.), 336(7636), pp. 134-8. doi:10.1136/bmj.39408.481898.BE.
Graff MJ, et al. Community Occupational Therapy for Older Patients With Dementia and Their Care Givers: Cost Effectiveness Study. BMJ. 2008 Jan 19;336(7636):134-8. PubMed PMID: 18171718.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study. AU - Graff,Maud J L, AU - Adang,Eddy M M, AU - Vernooij-Dassen,Myrra J M, AU - Dekker,Joost, AU - Jönsson,L, AU - Thijssen,Marjolein, AU - Hoefnagels,Willibrord H L, AU - Rikkert,Marcel G M Olde, Y1 - 2008/01/02/ PY - 2008/1/4/pubmed PY - 2008/3/4/medline PY - 2008/1/4/entrez SP - 134 EP - 8 JF - BMJ (Clinical research ed.) JO - BMJ VL - 336 IS - 7636 N2 - OBJECTIVE: To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint. DESIGN: Cost effectiveness study alongside a single blind randomised controlled trial. SETTING: Memory clinic, day clinic of a geriatrics department, and participants' homes. Patients 135 patients aged > or =65 with mild to moderate dementia living in the community and their primary care givers. INTERVENTION: 10 sessions of occupational therapy over five weeks, including cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision. MAIN OUTCOME MEASURES: Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment (that is, a combined patient and care giver outcome measure of clinically relevant improvement on process, performance, and competence scales) at three months after randomisation. Bootstrap methods used to determine confidence intervals for these measures. RESULTS: The intervention cost 1183 euros (848 pounds sterling, $1738) (95% confidence interval 1128 euros (808 pounds sterling, $1657) to 1239 euros (888 pounds sterling, $1820)) per patient and primary care giver unit at three months. Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were 1748 euros (1279 pounds sterling, $2621) lower in the intervention group, with the main cost savings in informal care. There was a significant difference in proportions of successful treatments of 36% at three months. The number needed to treat for successful treatment at three months was 2.8 (2.7 to 2.9). CONCLUSIONS: Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective, especially in terms of informal care giving. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/18171718/Community_occupational_therapy_for_older_patients_with_dementia_and_their_care_givers:_cost_effectiveness_study_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=18171718 DB - PRIME DP - Unbound Medicine ER -