Cost evaluation of a coordinated care management intervention for dementia.
OBJECTIVE
To calculate intervention costs and the potential cost offset of a care management intervention that substantially improved the quality of dementia care.


METHODS
From both a payer perspective and a social planner perspective, we analyzed data from a cluster randomized controlled trial (RCT) evaluating this intervention versus usual care. The RCT included 408 pairs of older adults with dementia and their caregivers. Caregivers were surveyed at baseline, at 12 months, and at 18 months to assess patient healthcare utilization and out-of-pocket costs.


METHODS
We calculated fixed and per-patient intervention costs from RCT records. We combined the monthly per-patient costs of healthcare services, informal caregiving, and out-of-pocket costs, and we conducted multivariate analyses comparing this sum (potential cost offset) for intervention versus usual care patients. Covariates included patient age, sex, and baseline costs. We limited the main analysis to patients who survived until the 12-month survey or the 18-month survey.


RESULTS
The intervention required a start-up cost of $70,256 and mean intervention per-patient per month costs of $118. There were no significant differences in the mean monthly cost of healthcare and caregiving services for intervention versus usual care patients using the societal perspective (difference of -$555 per month, P = .28) or the payer perspective (difference of -$219 per month [including nursing home costs], P = .55; difference of -$256 per month [excluding nursing home costs], P = .47).


CONCLUSIONS
Although this analysis of a dementia care management intervention did not demonstrate a significant cost offset, the intervention may represent a worthwhile approach to improving the quality of care and health outcomes for patients with dementia and their caregivers.
Duru
O Kenrik
OK
Department of Medicine, University of California, Los Angeles, Los Angeles, CA 90024, USA. kduru@mednet.ucla.edu
Ettner
Susan L
SL
Vassar
Stefanie D
SD
Chodosh
Joshua
J
Vickrey
Barbara G
BG
D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000191:economics / Q000706:statistics & numerical data; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003704:Dementia / Q000191:economics* / Q000628:therapy; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D010346:Patient Care Management / Q000191:economics* / Q000458:organization & administration; D014481:United States