Economic evaluation alongside a single RCT of an integrative psychotherapeutic nursing home programmeReport as inadecuate

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BMC Health Services Research

, 13:370

Utilization, expenditure, economics and financing systems


BackgroundThere is an 80% prevalence of two or more psychiatric symptoms in psychogeriatric patients. Multiple psychiatric symptoms MPS have many negative effects on quality of life of the patient as well as on caregiver burden and competence. Irrespective of the effectiveness of an intervention programme, it is important to take into account its economic aspects.

MethodsThe economic evaluation was performed alongside a single open RCT and conducted between 2001 and 2006. The patients who met the selection criteria were asked to participate in the RCT. After the patient or his caregiver signed a written informed consent form, he was then randomly assigned to either IRR or UC.

The costs and effects of IRR were compared to those of UC. We assessed the cost-utility of IRR as well as the cost-effectiveness of both conditions. Primary outcome variable: severity of MPS NPI of patients; secondary outcome variables: general caregiver burden CB and caregiver competence CCL, quality of life EQ5D of the patient, and total medical costs per patient TiC-P. Cost-utility was evaluated on the basis of differences in total medical costs. Cost-effectiveness was evaluated by comparing differences of total medical costs and effects on NPI, CB and CCL Incremental Cost-Effectiveness Ratio: ICER. CEAC-analyses were performed for QALY and NPI-severity. All significant testing was fixed at p<0.05 two-tailed. The data were analyzed according to the intention-to-treat ITT-principle. A complete cases approach CC was used.

ResultsIRR turned out to be non-significantly, 10.5% more expensive than UC € 36 per day. The number of QALYs was 0.01 higher non-significant in IRR, resulting in € 276,290 per QALY. According to the ICER-method, IRR was significantly more cost-effective on NPI-sum-severity of the patient up to 34%, CB and CCL up to 50%, with ICERs varying from € 130 to € 540 per additional point of improvement.

ConclusionsNo significant differences were found on QALYs. In IRR patients improved significantly more on severity of MPS, and caregivers on general burden and competence, with incremental costs varying from € 130 to € 540 per additional point of improvement. The surplus costs of IRR are considered acceptable, taking into account the high societal costs of suffering from MPS of psychogeriatric patients and the high burden of caregivers. The large discrepancy in economic evaluation between QALYs based on EQ5D and ICERs based on clinically relevant outcomes demands further research on the validity of EQ5D in psychogeriatric cost-utility studies. Trial registration nr.: ISRCTN 38916563; December 2004.

KeywordsEconomic evaluation Nursing home Cognitive impairment Neuropsychiatric symptoms Psychiatry BPSD Psychotherapy Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-13-370 contains supplementary material, which is available to authorized users.

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Author: Leona Hakkaart-van Roijen - Ton JEM Bakker - Maiwenn Al - Jacqueline van der Lee - Hugo J Duivenvoorden - Miel W Ribbe -


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