title: The Cost-Effectiveness of Two Forms of Case Management Compared to a Control Group for Persons with Dementia and Their Informal Caregivers from a Societal Perspective.
abstract: OBJECTIVE
  The objective of this article was to compare the costs and cost-effectiveness of the two most prominent types of case management in the Netherlands (intensive case management and linkage models) against no access to case management (control group) for people with already diagnosed dementia and their informal caregivers.
  
  
  METHODS
  The economic evaluation was conducted from a societal perspective embedded within a two year prospective, observational, controlled, cohort study with 521 informal caregivers and community-dwelling persons with dementia. Case management provided within one care organization (intensive case management model, ICMM), case management where care was provided by different care organizations within one region (Linkage model, LM), and a group with no access to case management (control) were compared. The economic evaluation related incremental costs to incremental effects regarding neuropsychiatric symptoms (NPI), psychological health of the informal caregiver (GHQ-12), and quality adjusted life years (QALY) of the person with dementia and informal caregiver.
  
  
  RESULTS
  Inverse-propensity-score-weighted models showed no significant differences in clinical or total cost outcomes between the three groups. Informal care costs were significantly lower in the ICMM group compared to both other groups. Day center costs were significantly lower in the ICMM group compared to the control group. For all outcomes, the probability that the ICMM was cost-effective in comparison with LM and the control group was larger than 0.97 at a threshold ratio of 0 €/incremental unit of effect.
  
  
  CONCLUSIONS
  This study provides preliminary evidence that the ICMM is cost-effective compared to the control group and the LM. However, the findings should be interpreted with caution since this study was not a randomized controlled trial.
authors.affiliation: Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.|Department of Biostatistics, Yale School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: Janet
authors.initials: J
authors.lastname: MacNeil Vroomen
authors.affiliation: Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Bosmans
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Iris
authors.initials: I
authors.lastname: Eekhout
authors.affiliation: Department of General Practice and Elderly Care Medicine, and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: Joling
authors.affiliation: Department of General Practice and Elderly Care Medicine, and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: van Mierlo
authors.affiliation: Department of General Practice and Elderly Care Medicine, and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Franka J M
authors.initials: FJ
authors.lastname: Meiland
authors.affiliation: Department of General Practice and Elderly Care Medicine, and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Hein P J
authors.initials: HP
authors.lastname: van Hout
authors.affiliation: Department of Internal Medicine, University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, the Netherlands.|Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Sophia E
authors.initials: SE
authors.lastname: de Rooij