Paterson Luke, Elliott Rachel A, Constantinidou Fofi, David Renaud, Dawes Piers, Frison Eric, Hann Mark, Hussain Hannah, Leroi Iracema, Politis Antonis M, Thodi Chryssoula, Camacho Elizabeth M
Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK.
Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK.
Int J Geriatr Psychiatry. 2025 Jul;40(7):e70132. doi: 10.1002/gps.70132.
Interventions that enable people with dementia to retain some independence in activities of daily living (ADL) may delay transitions into residential care and offset sharp reductions in quality of life (QoL). The aim of this study was to estimate how effective a hypothetical intervention needs to be at preserving independence in home-dwelling people with dementia, to be cost-effective.
A decision-analytic model was constructed to compare costs and outcomes of a cohort of people with dementia in the United Kingdom and European Union over a 10-year period. At model entry, the cohort was distributed across low, moderate, or high levels of dependence. The impact of a hypothetical intervention that preserves independence was evaluated by reducing the proportion of people entering the model with moderate and high dependence. The model included costs for the intervention and health and social care resource use. Secondary analysis included estimated costs of informal care. Health benefit was measured as quality-adjusted life-years (QALYs).
The cost of the intervention was £570/person. At this cost, an intervention that resulted in 7.5% of the sample entering the model in a lower level of dependence (compared with no intervention) was likely to be cost-effective (£8690/QALY). An intervention costing £250/person would only need a 2.5% effect and one costing £1000/person would need to have a 10% effect to be potentially cost-effective. Including informal care costs increased the size of the effect required for the intervention to be cost-effective because more of the care provided at lower levels of dependence is informal.
Preserving independence in people with dementia may be a cost-effective way to help them live well for longer. Our results provide a guide on costs and required effects for those developing interventions to preserve independence in people with dementia.
能使痴呆症患者在日常生活活动（ADL）中保持一定独立性的干预措施，可能会延缓其向机构护理的过渡，并抵消生活质量（QoL）的大幅下降。本研究的目的是评估一种假设的干预措施在保持居家痴呆症患者独立性方面需要达到何种效果才具有成本效益。
构建了一个决策分析模型，以比较英国和欧盟一组痴呆症患者在10年期间的成本和结果。在模型开始时，该队列被分为低、中、高依赖程度。通过减少进入模型的中度和高度依赖人群的比例，评估了一种保持独立性的假设干预措施的影响。该模型包括干预措施以及健康和社会护理资源使用的成本。二次分析包括非正式护理的估计成本。健康效益以质量调整生命年（QALYs）衡量。
干预措施的成本为每人570英镑。在此成本下，一种能使7.5%的样本以较低依赖程度进入模型（与无干预相比）的干预措施可能具有成本效益（8690英镑/QALY）。成本为每人250英镑的干预措施只需产生2.5%的效果，而成本为每人1000英镑的干预措施则需要产生10%的效果才可能具有成本效益。纳入非正式护理成本会增加干预措施具有成本效益所需的效果规模，因为在较低依赖程度下提供的护理更多是非正式的。
保持痴呆症患者的独立性可能是帮助他们更长久地过上良好生活的一种具有成本效益的方式。我们的结果为那些开发旨在保持痴呆症患者独立性的干预措施的人员提供了成本和所需效果方面的指导。
