Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK.
Association for Dementia Studies, University of Worcester, Worcester, UK.
Health Soc Care Community. 2021 Nov;29(6):1756-1768. doi: 10.1111/hsc.13281. Epub 2021 Jan 27.
We examined the costs and cost-effectiveness of the Meeting Centre Support Programme (MCSP) implemented and piloted in the UK, Poland and Italy, replicating the Dutch Meeting Centre model. Dutch Meeting Centres combine day services for people with dementia with carer support. Data were collected over 2015-2016 from MCSP and usual care (UC) participants (people with dementia-carer dyads) at baseline and 6 months. We examined participants' health and social care (HSC), and societal costs, including Meeting Centre (MC) attendances. Costs and outcomes in MCSP and UC groups were compared. Primary outcomes: Persons with dementia: quality-adjusted life years (EQ-5D-5L-derived); QOL-AD. DQoL was examined as a secondary outcome. Carers: Short Sense of Competence Questionnaire (SSCQ). Incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves were obtained by bootstrapping outcome and cost regression estimates. Eighty-three MCSP and 69 UC dyads were analysed. The 6-month cost of providing MCSP was €4,703; participants with dementia attended MC a mean of 45 times and carers 15 times. Including intervention costs, adjusted 6-month HSC costs were €5,941higher in MCSP than in UC. From the HSC perspective: in terms of QALY, the probability of cost-effectiveness was zero over willingness-to-pay (WTP) ranging from €0 to €350,000. On QOL-AD, the probability of cost-effectiveness of MCSP was 50% at WTP of €5,000 for a one-point increase. A one-point gain in the DQoL positive affect subscale had a probability of cost-effectiveness of 99% at WTP over €8,000. On SSCQ, no significant difference was found between MCSP and UC. Evidence for cost-effectiveness of MCSP was mixed but suggests that it may be cost-effective in relation to gains in dementia-specific quality of life measures. MCs offer effective tailored post-diagnostic support services to both people with dementia and carers in a context where few evidence-based alternatives to formal home-based social services may be available.
我们考察了在英国、波兰和意大利实施并试点的会议中心支持计划（MCSP）的成本和成本效益，该计划复制了荷兰会议中心模式。荷兰会议中心将痴呆症患者的日间服务与护理人员支持相结合。数据于 2015 年至 2016 年期间从 MCSP 和常规护理（UC）参与者（痴呆症患者-护理人员二人组）在基线和 6 个月时收集。我们考察了参与者的健康和社会护理（HSC）以及包括会议中心（MC）出勤率在内的社会成本。比较了 MCSP 和 UC 组的成本和结果。主要结果：痴呆症患者：质量调整生命年（EQ-5D-5L 推导）；QOL-AD。DQoL 作为次要结果进行了考察。护理人员：短期感知能力问卷（SSCQ）。通过对结果和成本回归估计进行自举法获得增量成本效益比（ICER）和成本效益可接受性曲线。分析了 83 对 MCSP 和 69 对 UC 二人组。提供 MCSP 的 6 个月成本为 4703 欧元；患者平均参加 MC 45 次，护理人员 15 次。包括干预成本在内，MCSP 调整后的 6 个月 HSC 成本比 UC 高出 5941 欧元。从 HSC 的角度来看：就 QALY 而言，在从 0 到 350000 欧元的意愿支付范围内，MCSP 的成本效益概率为零。在 QOL-AD 方面，MCSP 的成本效益概率为 50%，在对 5000 欧元的一个点增加进行意愿支付。在 DQoL 积极影响子量表中获得一个点的增益，在 WTP 超过 8000 欧元时，具有成本效益的概率为 99%。在 SSCQ 方面，MCSP 和 UC 之间没有发现显著差异。MCSP 的成本效益证据喜忧参半，但表明它可能与痴呆症特定生活质量测量的收益有关，具有成本效益。在缺乏基于证据的替代正式家庭社会服务的情况下，会议中心为痴呆症患者和护理人员提供了有效的定制的诊断后支持服务。
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