title: The cost-effectiveness of grip on challenging behaviour: an economic evaluation of a care programme for managing challenging behaviour.
abstract: OBJECTIVE
  The objective of the study was to evaluate the cost-effectiveness of implementing the Grip on Challenging Behaviour care programme (GRIP) on dementia special care units in comparison with usual care.
  
  
  METHODS
  A stepped wedge design was used. Challenging behaviour and quality of life were measured using the Cohen Mansfield Agitation Inventory (CMAI) and the QUALIDEM. Quality-adjusted life years (QALYs) were calculated using the EuroQol-5D. Psychoactive medication use (range 0-5 per measurement) and sick leave were registered. Costs included medication, time spent on challenging behaviour and education. Costs and effects were analysed using linear multilevel regression. Incremental cost-effectiveness ratios were calculated. Statistical uncertainty was estimated using bootstrapping.
  
  
  RESULTS
  Seventeen dementia special care units participated. GRIP led to improvement on the QUALIDEM subscale social relations (1.6; 95% CI 0.18 to 3.4) and on the use of psychoactive medication (-0.73; 95% CI -1.1 to -0.46) and to a decrease in QALYs (-0.02; 95% CI -0.06 to -0.003). No significant effects on CMAI, sick leave and other QUALIDEM subscales were found. The intervention was not cost-effective in comparison with usual care with regard to CMAI score, QALYs and sick leave. The willingness to pay should be 320€/point improvement on the QUALIDEM subscale social relations and 370€/psychoactive medication less to reach a 0.95 probability of cost-effectiveness.
  
  
  CONCLUSIONS
  It depends on how much society is willing to pay whether GRIP can be considered cost-effective. Because the appropriateness of the current methods for analysing cost-effectiveness in this specific population is uncertain, the positive effects on behaviour, medication and job satisfactions should also be taken in account in the decision making.
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, the Netherlands.
authors.forename: S A
authors.initials: SA
authors.lastname: Zwijsen
authors.affiliation: Department of Health Sciences, EMGO+ Institute for Health and Care Research, Faculty of Earth Life Sciences, VU University, Amsterdam, the Netherlands.
authors.forename: J E
authors.initials: JE
authors.lastname: Bosmans
authors.affiliation: Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: D L
authors.initials: DL
authors.lastname: Gerritsen
authors.affiliation: Department of Clinical Psychology, EMGO+ Institute for Health and Care Research, Faculty of Psychological and Educational Sciences, VU University, Amsterdam, the Netherlands.|Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.|School of Psychology, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: A M
authors.initials: AM
authors.lastname: Pot
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, the Netherlands.
authors.forename: C M P M
authors.initials: CM
authors.lastname: Hertogh
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Smalbrugge
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D032763:Behavior Control / Q000379:methods*; D003362:Cost-Benefit Analysis; D003704:Dementia / Q000191:economics / Q000523:psychology*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes / Q000191:economics; D011595:Psychomotor Agitation; D011619:Psychotropic Drugs / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
chemical_list: D011619:Psychotropic Drugs
keywords: behaviour; cost-effectiveness; dementia; nursing home; stepped wedge design