Effectiveness and costs of post-diagnosis treatment in dementia...


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Title Effectiveness and costs of post-diagnosis treatment in dementia coordinated by multidisciplinary memory clinics in comparison to treatment coordinated by GPs. (AD-EURO study)
Period 01 / 2007 - 01 / 2010
Status Completed
Research number OND1326377
Data Supplier Website ZonMw


Primary aim is to determine the effectiveness and efficiency of post-diagnosis drug treatment and care-coordination for patients suffering from dementia, and their caregivers, as carried out by multidisciplinary memory clinics (MMC) within the Netherlands compared to the control group, in which General Practitioners (GPs) co-ordinate post diagnosis treatment.SECONDARY AIM is to study differences in efficiency between different MMCs related to the compliance, outcome, processes and staff involved in post-diagnosis care in AD patients, and to formulate recommendations for MMCs to optimize efficiency. RESEARCH QUESTIONSThe principle research question to be answered is whether the post-diagnosis treatment of dementia patients carried out by MMCs is cost-effective, or whether thid treatement can be carried out more efficiently by GPs?This main question will be solved by answering 6 sub-questions:1.What is the effectiveness of MMCs in post-diagnosis treatment and care of patients suffering from dementia, consisting of targeted symptomatic drug treatment and psychosocial interventions in case of comorbidity and/or behavioural disturbances, on their self-perceived quality of life and functional performance compared with post-diagnosis treatment supplied by GPs?2.What is the effectiveness of MMCs for this post-diagnosis treatment and care for dementia patients and their caregivers on the burden of care perceived by these caregivers, compared to care for patients and their caregivers as given by GPs?3.What is the effectiveness of MMCs for this post-diagnosis treatment and care in the realisation of quality of care indicators in dementia such as adherence to drug- and care advices and continuity of care, compared to GPs?4.What is the incremental cost-effectiveness ratio, from a societal perspective, for the first 12 months of post-diagnosis care and guidance of dementia patients and their caregivers by MMCs compared to post-diagnosis care deliverd by GPs? What is the outcome for a 5 year time-horizon?5.What are the incremental costs per QALY gained by the patients, and per QALY gained by their caregivers, compared to usual post diagnosis care as given by GPs? 6.What do differences in outcome between MMCs learn us to improve the quality of the production process (e.g. patients compliance) and efficiency of MMCs?HEALTH TECHNOLOGY ASSESSMENT-ANNEX STUDYWe also propose an Annex-study in which we study how Proxy-QoL assessment can be determined, analysed and interpreted best in economic evaluations. BACKGROUND: In The Netherlands a rapidly increasing number of multidisciplinary memory clinics (MMC) currently diagnose 25% of the patients with dementia. Following the diagnostic work-up, MMCs are increasingly involved in post-diagnosis treatment and co-ordination of care, which probably is very important for patients and caregivers, but also very time consuming and expensive. This study will focus on the important question whether this complex post-diagnosis treatment and care co-ordination, evaluated both on effectiveness and costs, should be carried out by MMCs (intervention) or by General Practitioners (GPs) (control) as pivot of delivery of health care for these patients. OBJECTIVES: To determine, given a societal perspective, MMCs effectiveness and costs in post-diagnosis care for dementia-patients to improve or stabilize patients health related quality of life and performances in daily living and to improve informal caregivers perceived burden of care. STUDY DESIGN: Controlled, cluster randomized study on effectiveness and costs, in which 300 GPs are randomised over intervention and control condition. All GPs in the referral area of the 6 participating MMCs are invited to participate in the study. STUDY POPULATION/DATA SETS: 220 patients suffering from mild to moderate dementia (DSM-IVTR dementia criteria and Clinical Dementia Rating 1 to 2), and 220 informal caregivers, will receive either the intervention or control conditionINTERVENTION: MMCs will deliver 12 months of post-diagnosis treatment and care, which consists of: 1. Initiating, targeting and monitoring acethylcholinesterase inhibitors (AChI), as symptomatic drug treatment in case of Alzheimer s disease (AD). 2. Other drug interventions in patients with other types of dementia and/or psychiatric or somatic co-morbidity. 3. Initiating psychosocial interventions and care-coordination. CONTROL: In the control group the patients with dementia will be referred back to the GP after diagnosis has been made, with advices on drug treatment, and on psychosocial interventions and care-planning. GPs will co-ordinate this care, but can also refer to a range of other services as they currently do in regular practice without MMCs in their health region. PRIMARY OUTCOME MEASURES: Patients: Health-related quality of life as measured with a dementia specific HrQoL-instrument (i.e. QoL-AD) and functional performance in daily living as measured by the IDDD (Instrumental activities of Daily living in Dementia Diagnosis); Informal caregivers: caregiver burden as measured with the Sense of Competence Questionnaire (SoCQ). POWER/DATA ANALYSIS: 220 patients are required to be included for a power of 80%, reached with 160 patients who can be fully evaluated. For this calculation we used: a two-sided significance level of 0.05, an attrition rate of 30%, and an intraclasscorrelation of 0.1. ECONOMIC EVALUATION: Costs will be assessed from a societal perspective, using the Resource Utilization in Dementia-questionnaire (RUD), which has been used in several other economic evaluations in AD treatment. An incremental cost-utility ratio (costs per QALY) and an incremental cost-effectiveness ratio, for a meaningful change in Qol-AD and functional performance in patients and SoCQ in proxies will be calculated. Long-term economic outcome will be estimated with a Markov model.TIME SCHEDULE: The study will take 36 months: 6 months preparation, 12 months inclusion of GPs and patients/proxies, 12 months follow-up and 6 months analysis and reporting.HTA-ANNEX STUDY: it is highly relevant for this and forthcoming economic evaluations to clarify the relationship between proxy and patient assessment of Quality of life, of which the latter probably becomes less reliable with progression in cognitive decline.

Abstract (NL)

Deze studie beoogt een economische evaluatie van de snel groeiende post-diagnose behandeling van patiƫnten met een dementie door geheugenpoliklinieken (MMC). OPZET: In een clusterrandomisatie op huisartsniveau wordt de behandeling door 6 MMCs vergeleken met die door de huisartsen (GPs). PATIENTEN: Pten met een dementie (DSM IV) van matige ernst en hun mantelzorgers.INTERVENTIE: Volledige post-diagnose behandeling, medicamenteus en niet-medicamenteus) en zorg gedurende 12 maand geregeld door de MMCs.CONTROLE: Volledige post-diagnose behandeling en zorg gedurende 12 maand gecoordineerd door de GPs.PRIMAIRE UITKOMSTMATEN: Kwaliteit van leven en funcioneel niveau bij de patiƫnt en zorgbelasting bij de mantelzorger.ECONIMISCHE EVALUATIE: met maatschappelijk perspectief worden de kosten per QALY gezondheidswinst en per responder op de primaire uitkomstmaat voor patient en mantelzorger bepaald.DUUR: 36 maanden, waarvan 12 maand inclusie en 12 maand follow-up.Er wordt bovendien een HTA-annex studie uitgevoerd op het thema proxies.

Related organisations

Secretariat Department of Geriatrics (RU)
Financier ZonMw

Related people


D23230 Neurology, otorhinolaryngology, opthalmology
D23363 Geriatrics

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