Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study

doi:10.1136/bmj.39408.481898.BE

BMJ 2008;336:134-138 (19 January), doi:10.1136/bmj.39408.481898.BE (published 2 January 2008)

Research

Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study

Maud J L Graff, scientific researcher in allied healthcare research¹^,3, Eddy M M Adang, senior researcher in efficiency studies², Myrra J M Vernooij-Dassen, professor in psychosocial aspects of care for frail elderly³, Joost Dekker, professor in allied health care⁴, L Jönsson, senior researcher in health economic studies⁵, Marjolein Thijssen, research assistant¹^,3, Willibrord H L Hoefnagels, professor in geriatrics⁶, Marcel G M Olde Rikkert, professor in geriatrics⁶

¹ Alzheimer Centre Nijmegen, Department of Occupational Therapy 897, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, Netherlands, ² Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, ³ Alzheimer Centre Nijmegen, Department of Quality of Care Research, Radboud University Nijmegen Medical Centre, ⁴ Department of Rehabilitation Medicine, Free University Medical Centre Amsterdam, Amsterdam, Netherlands, ⁵ Division of Geriatric Epidemiology, Neurotec Department, Karolinska Institute, Stockholm, Sweden, ⁶ Alzheimer Centre Nijmegen, Department of Geriatrics 925, Radboud University Nijmegen Medical Centre

Correspondence to: M J L Graff m.graff{at}pmd.umcn.nl

Objective To assess the cost effectiveness of community basedoccupational therapy compared with usual care in older patientswith dementia and their care givers from a societal viewpoint.

Design Cost effectiveness study alongside a single blind randomisedcontrolled trial.

Setting Memory clinic, day clinic of a geriatrics department,and participants’ homes.

Patients 135 patients aged $≥$ 65 with mild to moderate dementialiving in the community and their primary care givers.

Intervention 10 sessions of occupational therapy over five weeks,including cognitive and behavioural interventions, to trainpatients in the use of aids to compensate for cognitive declineand care givers in coping behaviours and supervision.

Main outcome measures Incremental cost effectiveness ratio expressedas the difference in mean total care costs per successful treatment(that is, a combined patient and care giver outcome measureof clinically relevant improvement on process, performance,and competence scales) at three months after randomisation.Bootstrap methods used to determine confidence intervals forthese measures.

Results The intervention cost ${euro}$ 1183 (£848, $1738) (95%confidence interval ${euro}$ 1128 (£808, $1657) to ${euro}$ 1239 (£888,$1820)) per patient and primary care giver unit at three months.Visits to general practitioners and hospital doctors cost thesame in both groups but total mean costs were ${euro}$ 1748 (£1279,$2621) lower in the intervention group, with the main cost savingsin informal care. There was a significant difference in proportionsof successful treatments of 36% at three months. The numberneeded to treat for successful treatment at three months was2.8 (2.7 to 2.9).

Conclusions Community occupational therapy intervention forpatients with dementia and their care givers is successful andcost effective, especially in terms of informal care giving.

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BMJ 2007 334: 594-595. [Extract] [Full Text] [PDF]

Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial: Maud J L Graff, Myrra J M Vernooij-Dassen, Marjolein Thijssen, Joost Dekker, Willibrord H L Hoefnagels, and Marcel G M Olde Rikkert
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Rapid Responses:

Read all Rapid Responses

Needs culture based interventions of community occupational therapy for dementia: Om Prakash
bmj.com, 18 Jan 2008 [Full text]
Worth considering in UK: Viran Kansagara, et al.
bmj.com, 19 Jan 2008 [Full text]
Implications of community-based occupational therapy: Kenneth A Hoekstra
bmj.com, 3 Jun 2008 [Full text]