Cost-effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM-E randomised controlled trial.
OBJECTIVE
Although available evidence is modest, exercise could be beneficial in reducing behavioural and psychological symptoms of dementia. We aim to evaluate the cost-effectiveness of a dyadic exercise regimen for individuals with dementia and their main carer as therapy for behavioural and psychological symptoms of dementia.


METHODS
Cost-effectiveness analysis within a two-arm, pragmatic, randomised, controlled, single-blind, parallel-group trial of a dyadic exercise regimen (individually tailored, for 20-30 min at least five times per week). The study randomised 131 community-dwelling individuals with dementia and clinically significant behavioural and psychological symptoms with a carer willing and able to participate in the exercise regimen; 52 dyads provided sufficient cost data for analyses.


RESULTS
Mean intervention cost was £284 per dyad. For the subsample of 52 dyads, the intervention group had significantly higher mean cost from a societal perspective (mean difference £2728.60, p = 0.05), but costs were not significantly different from a health and social care perspective. The exercise intervention was more cost-effective than treatment as usual from both societal and health and social care perspectives for the measure of behavioural and psychological symptoms (Neuropsychiatric Inventory). It does not appear cost-effective in terms of cost per quality-adjusted life year gain.


CONCLUSIONS
The exercise intervention has the potential to be seen as cost-effective when considering behavioural and psychological symptoms but did not appear cost-effective when considering quality-adjusted life year gains.
Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
Francesco
F
D'Amico
Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
Amritpal
A
Rehill
Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
Martin
M
Knapp
Central and North West London NHS Foundation Trust (CNWL), London, UK.
David
D
Lowery
Central and North West London NHS Foundation Trust (CNWL), London, UK.|University College London (UCL), London, UK.
Arlinda
A
Cerga-Pashoja
University College London (UCL), London, UK.
Mark
M
Griffin
University College London (UCL), London, UK.
Steve
S
Iliffe
Central and North West London NHS Foundation Trust (CNWL), London, UK.|Imperial College London, London, UK.
James
J
Warner
D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003704:Dementia / Q000191:economics / Q000523:psychology / Q000628:therapy*; D005081:Exercise Therapy / Q000191:economics / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016037:Single-Blind Method; D013315:Stress, Psychological / Q000517:prevention & control; D016138:Walking
NPI; cost-effectiveness; dementia; exercise