title: Transitions between care settings in dementia: are they relevant in economic terms?
abstract: OBJECTIVE
  This study was performed to assess the economic effect of interventions affecting transitions between dementia care settings in Germany.
  
  
  METHODS
  A Markov-model that models the course of dementia with respect to typical care setting transitions was derived. Model data and parameters were retrieved by literature reviews. A deterministic and probabilistic sensitivity analysis was conducted to account for parameter uncertainty.
  
  
  RESULTS
  In the base case, the expected present value of remaining lifetime costs is €25,326 for each cohort member. As a function of effectiveness, pharmaceutical interventions may reduce the costs by 2% to 13% and psychosocial interventions come with savings of 1% to 10%. A structural intervention-promoting group living as a substitute for nursing home care increases costs by 2% to 8%. Sensitivity analyses indicate high variance and variability of results, as well as valuation of informal care being a crucial parameter.
  
  
  CONCLUSIONS
  There are economic benefits of delayed transitions to institutional settings, especially from the viewpoint of statutory care insurances, but these do unlikely exceed intervention costs. Thus, further intervention effects should be considered. Ultimately, concentrating research on preventive and protective factors of dementia could lead to an efficient intervention from every perspective.
authors.affiliation: Faculty of Law and Business Administration, Chair of Business Administration and Health Care Management, Greifswald, Germany; German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany. Electronic address: sven.lueke@rub.de.
authors.forename: Sven
authors.initials: S
authors.lastname: Lueke
authors.affiliation: German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany; Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hoffmann
authors.affiliation: Faculty of Law and Business Administration, Chair of Business Administration and Health Care Management, Greifswald, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Fleβa
mesh_terms: D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000191:economics* / Q000639:trends; D003704:Dementia / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology; D016352:Group Homes / Q000191:economics* / Q000639:trends; D006699:Home Care Services / Q000191:economics* / Q000639:trends; D006801:Humans; D008390:Markov Chains; D009026:Mortality / Q000639:trends; D009735:Nursing Homes / Q000191:economics* / Q000639:trends
keywords: cost; dementia; group living; modeling; nursing home