Journal Article

Cost–utility analysis of adapted problem adaptation therapy for depression in mild-to-moderate dementia caused by Alzheimer's disease: PATHFINDER randomised controlled trial

Wiegand, Martin, Panca, Monica, Cort, Elizabeth, Freemantle, Nick, Harwood, Rowan, Rawlinson, Charlotte, Fox, Chris, Gould, Rebecca L., Hunter, Rachael Maree, Thomas, Alan, Moniz-Cook, Esme, Howard, Robert, Livingston, Gill, Wilkinson, Philip, Russell, Gregor, Downey, Anne Marie, Banerjee, Sube

2024

Overview

Depression is common in people with dementia, and negatively affects quality of life. This paper aims to evaluate the cost-effectiveness of an intervention for depression in mild and moderate dementia caused by Alzheimer's disease over 12 months (PATHFINDER trial), from both the health and social care and societal perspectives. A total of 336 participants were randomised to receive the adapted PATH intervention in addition to treatment as usual (TAU) ( = 168) or TAU alone ( = 168). Health and social care resource use were collected with the Client Service Receipt Inventory and health-related quality-of-life data with the EQ-5D-5L instrument at baseline and 3-, 6- and 12-month follow-up points. Principal analysis comprised quality-adjusted life-years (QALYs) calculated from the participant responses to the EQ-5D-5L instrument. The mean cost of the adapted PATH intervention was estimated at £1141 per PATHFINDER participant. From a health and social care perspective, the mean difference in costs between the adapted PATH and control arm at 12 months was -£74 (95% CI -£1942 to £1793), and from the societal perspective was -£671 (95% CI -£9144 to £7801). The mean difference in QALYs was 0.027 (95% CI -0.004 to 0.059). At £20 000 per QALY gained threshold, there were 74 and 68% probabilities of adapted PATH being cost-effective from the health and social care and societal perspective, respectively. The addition of the adapted PATH intervention to TAU for people with dementia and depression generated cost savings alongside a higher quality of life compared with TAU alone; however, the improvements in costs and QALYs were not statistically significant.

• Publisher: Cambridge University Press
• Subject: Adaptation / Alzheimer's disease / Caregivers / Cost analysis / cost-effectiveness / cost-utility / Dementia / Dementia disorders / depression / Intervention / Memory / Mental depression / Mental Health Services / Older people / Problem solving / Quality of life / quality-adjusted life years / Questionnaires / Social services / Therapists / Therapy / Training