Cost-effectiveness of a digitally supported care management program for caregivers of people with dementia.

Abstract

Objectives: To examine the cost-effectiveness of a digitally supported care management system (CMS) for caregivers of People with Dementia (PwD) compared with usual care.

Methods: The analysis was based on 192 caregivers (n=96 CMS, n=96 usual care) of PwD in a cluster-randomized, controlled trial testing a digitally supported CMS, aiming to identify and address caregivers' unmet needs and develop and implement an individualized support and care plan over six months. Incremental costs from the public-payer and societal perspective, quality-adjusted life-years (QALY), and the incremental cost-effectiveness ratio (ICER) six months after baseline were calculated using multivariate regression models. We assessed the probability of cost effectiveness using a range of willingness-to-pay thresholds (WTP).

Results: Caregivers in the intervention gained QALYs (+0.004 [CI^95%-0.003-0.012], p-value=.225) and had lower costs from the public-payer (-378€ [1,926-1,168], p-value=.630), but higher costs from the societal perspective (+1,324 [-3,634-6,284], p-value=.599). The intervention dominates usual care from the payer perspective, while the ICER was 331,000€/QALY from a societal perspective. The probability of cost-effectiveness was 72% and 79% from the public payer and 33% and 35% from a societal perspective at the WTP threshold of 40,000€ and 80,000€/QALY gained.

Discussion: CMS was likely cost-effective from the payer but not from a societal perspective, underlining the importance of informal care. The gain in QALY was marginal and could be due to the short observation period. Focusing on both the caregiver and the PwD, rather than assessing the PwD needs through the caregiver, could improve the cost-effectiveness results.