A cost effectiveness analysis of maintenance cognitive stimulation therapy (MCST) for people with dementia: examining the influence of cognitive ability and living arrangements

ABSTRACT

Objectives: Identify if cost-effectiveness of Maintenance Cognitive Simulation Therapy (MCST) differs by type of living arrangement and cognitive ability of the person with dementia. Next, a value of information analysis is performed to inform decisions about future research.

Methods: Incremental cost-effectiveness analysis applying seemingly unrelated regressions using data from a multicentre RCT of MCST versus treatment as usual in a population which had already received 7 weeks of CST for dementia (ISRCTN: 26286067). The findings from the cost-effectiveness analysis are used to inform a value of information analysis.

Results: The results are dependent upon how quality adjusted life years (QALYs) are measured. MCST might be cost-effective compared to standard treatment for those who live alone and those with higher levels of cognitive functioning. If a further RCT was to be conducted for this sub-group of the population, value of information analysis suggests a total sample of 48 complete cases for both sub-groups would be required for a two-arm trial. The expected net gain of conducting this future research is £920 million.

Conclusion: Preliminary results suggest that MCST may be most cost-efficient for people with dementia who live alone and/or who have higher cognition. Future research in this area is needed.

KEYWORDS:

• Maintenance cognitive simulation therapy
• cognitive functioning
• residency
• cost-effectiveness
• expected value of sample information

Disclosure statement

Dr. Orrell reports grants from National Institute of Health Research, during the conduct of the study; In addition, Dr. Orrell has a patent Making a difference Manuals—copyright Hawker publications with royalties paid.

Additional information

Funding

This work was supported by the National Institute for Health Research (NIHR) via a ‘NIHR Research Professorship’ award to LR (Reference Number NIHR-RP-011–043). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.