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

BMJ 2008; 336 doi: (Published 17 January 2008) Cite this as: BMJ 2008;336:134
  1. Maud J L Graff, scientific researcher in allied healthcare research13,
  2. Eddy M M Adang, senior researcher in efficiency studies2,
  3. Myrra J M Vernooij-Dassen, professor in psychosocial aspects of care for frail elderly3,
  4. Joost Dekker, professor in allied health care4,
  5. L Jönsson, senior researcher in health economic studies5,
  6. Marjolein Thijssen, research assistant13,
  7. Willibrord H L Hoefnagels, professor in geriatrics6,
  8. Marcel G M Olde Rikkert, professor in geriatrics6
  1. 1Alzheimer Centre Nijmegen, Department of Occupational Therapy 897, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, Netherlands
  2. 2Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre
  3. 3Alzheimer Centre Nijmegen, Department of Quality of Care Research, Radboud University Nijmegen Medical Centre
  4. 4Department of Rehabilitation Medicine, Free University Medical Centre Amsterdam, Amsterdam, Netherlands
  5. 5Division of Geriatric Epidemiology, Neurotec Department, Karolinska Institute, Stockholm, Sweden
  6. 6Alzheimer Centre Nijmegen, Department of Geriatrics 925, Radboud University Nijmegen Medical Centre
  1. Correspondence to: M J L Graff m.graff{at}
  • Accepted 4 November 2007


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

Design Cost effectiveness study alongside a single blind randomised controlled trial.

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

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

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

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

Results The intervention cost €1183 (£848, $1738) (95% confidence interval €1128 (£808, $1657) to €1239 (£888, $1820)) per patient and primary care giver unit at three months. Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were €1748 (£1279, $2621) lower in the intervention group, with the main cost savings in informal care. There was a significant difference in proportions of successful treatments of 36% at three months. The number needed to treat for successful treatment at three months was 2.8 (2.7 to 2.9).

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


  • We thank all participants for their contribution and Jana Zajec and Patricia Verstraten for occupational therapy treatments.

  • Contributors: All investigators were involved in the study design. MJLG was the lead investigator, developed the study design, acquired data, analysis, interpretations, and wrote the paper. EMMA, MJMV-D, JD, MGMOR, and WHLH were responsible for the design and supervision, and wrote the paper. LJ also wrote the paper. MT acquired data. MGMOR acquired data and is guarantor.

  • Funding: Fund VCVGZ, the Dutch Alzheimer Association with financial support of the Radboud University Nijmegen Medical Centre, and the Dutch Occupational Therapy Association.

  • Competing interests: None declared.

  • Ethical approval: Medical ethics committee of the Radboud University Nijmegen Medical Centre of Nijmegen and Arnhem, No CWOM0012-0292.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 4 November 2007
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