Cost–utility analysis of the DREAMS START intervention for people living with dementia and their carers: a within-trial economic evaluation

IF 13.4 Q1 GERIATRICS & GERONTOLOGY

Lancet Healthy Longevity Pub Date : 2025-05-01 DOI:10.1016/j.lanhl.2025.100708

Lina Gonzalez MSc , Prof Penny Rapaport PhD , Prof Gill Livingston MD , Sarah Amador PhD , Mariam O Adeleke PhD , Prof Julie A Barber PhD , Prof Sube Banerjee MD , Prof Georgina Charlesworth PhD , Chris Clarke DClinPsy , Prof Colin A Espie DSc , Prof Simon D Kyle PhD , Malgorzata Raczek PhD , Prof Zuzana Walker MD , Lucy Webster PhD , Monica Manela BM , Prof Rachael Maree Hunter MSc

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引用次数: 0

Abstract

Background

People living at home with dementia frequently have disturbed sleep. The multicomponent, non-pharmacological intervention DREAMS START has shown to be effective at improving sleep in this population. We aimed to conduct a cost–utility analysis of DREAMS START compared with treatment as usual (TAU).

Methods

This economic evaluation within a single-masked, phase 3, parallel-arm, superiority randomised controlled trial involved dyads of people with dementia and sleep disturbance and their family carer. Participants were recruited from the National Health Service and the Join Dementia Research service in England. Dyads were randomly assigned (1:1) to receive the DREAMS START intervention (plus TAU) or TAU. Randomisation was blocked, with stratification by site, and a web-based system was used for allocation. Researchers collecting outcome data were masked to allocation group. The primary outcome was sleep disturbance measured by the Sleep Disorders Inventory (SDI) at 8 months. At baseline, 4 months, and 8 months, family carers completed the 5-level EuroQoL 5 dimensions (EQ-5D-5L) proxy, the Dementia Quality of Life Instrument (DEMQOL)-Proxy, and EQ-5D-5L questionnaires, and resource use for the patient and family carer was measured. We calculated the probability that the DREAMS START intervention is cost-effective from a health and personal social services perspective and from a wider societal perspective for a range of decision thresholds per quality-adjusted life-year (QALY) gained using the EQ-5D-5L scores to calculate QALYs and imputing missing data, reported with a cost-effectiveness acceptability curve. This trial was registered with ISRCTN, 13072268, and is complete.

Findings

From Feb 24, 2021, to March 5, 2023, we randomly assigned 377 dyads: 188 to the intervention group and 189 to the TAU group. The mean age of participants with dementia was 79⋅4 years (SD 9⋅0), 206 (55%) of whom were women and 171 (45%) were men. As previously reported, the mean SDI score at 8 months was lower in the intervention group than in the TAU group (adjusted difference in means –4·70 [95% CI –7·65 to –1·74], p=0·002). The mean incremental difference in health and personal social services costs was £59 less per dyad (95% CI −5168 to 5050) and, when incorporating wider societal costs, was £116 less per dyad (−5769 to 5536) for the intervention group than the TAU group, although these figures were non-significant. The mean incremental difference in QALYs per person with dementia was 0·016 more (95% CI 0·000 to 0·033) for the intervention group than for the TAU group, indicating no significant difference in quality of life. At a £20 000 per QALY gained decision threshold, there was a 78% probability that DREAMS START is cost-effective, compared with TAU.

Interpretation

DREAMS START is likely to be cost-effective. Given its clinical effectiveness, we recommend that this intervention forms part of routine care for people with dementia and disturbed sleep.

Funding

National Institute for Health and Care Research Health Technology Assessment.

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对痴呆症患者及其照护者的DREAMS START干预的成本效用分析：试验内经济评估

背景：住在家里的痴呆症患者经常有睡眠障碍。多组分、非药物干预的DREAMS START已被证明对改善这一人群的睡眠是有效的。我们的目的是对DREAMS START与常规治疗（TAU）进行成本效用分析。方法：在一项单盲、3期、平行对照、优势随机对照试验中进行经济评估，该试验涉及痴呆和睡眠障碍患者及其家庭护理人员。参与者是从英国国民健康服务中心和痴呆症研究中心招募的。二人组被随机分配（1:1）接受DREAMS START干预（加TAU）或TAU。随机化被阻止，按地点分层，并使用基于网络的系统进行分配。收集结果数据的研究人员被屏蔽到分配组。主要结局是8个月时通过睡眠障碍量表（SDI）测量睡眠障碍。在基线、4个月和8个月时，家庭护理人员完成了5级EuroQoL 5维度（EQ-5D-5L）代理、痴呆生活质量工具（DEMQOL）代理和EQ-5D-5L问卷，并测量了患者和家庭护理人员的资源使用情况。我们从健康和个人社会服务的角度计算了DREAMS START干预具有成本效益的可能性，并从更广泛的社会角度计算了每个质量调整生命年（QALY）的决策阈值范围，使用EQ-5D-5L评分计算QALY并输入缺失数据，报告了成本效益可接受曲线。该试验已在ISRCTN注册，编号13072268，现已完成。研究结果：从2021年2月24日至2023年3月5日，我们随机分配了377对：干预组188对，TAU组189对。痴呆患者的平均年龄为79⋅4岁（SD 9⋅0），其中女性206人（55%），男性171人（45%）。如先前报道，干预组8个月时的平均SDI评分低于TAU组（调整后的平均值差为- 4.70 [95% CI - 7.65至- 1.74],p= 0.002）。健康和个人社会服务成本的平均增量差异为每双少59英镑（95% CI -5168至5050），当纳入更广泛的社会成本时，干预组比TAU组每双少116英镑（-5769至5536），尽管这些数字不显著。与TAU组相比，干预组每位痴呆患者QALYs的平均增量差异为0.016 (95% CI为0.000至0.033)，表明生活质量无显著差异。在每个QALY获得的决策阈值为20,000英镑时，与TAU相比，DREAMS START具有成本效益的可能性为78%。解读：DREAMS START很可能具有成本效益。鉴于其临床效果，我们建议将这种干预作为痴呆症和睡眠障碍患者常规护理的一部分。资助：国家卫生与保健研究所卫生技术评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Healthy Longevity GERIATRICS & GERONTOLOGY-

CiteScore

16.30

自引率

2.30%

发文量

192

审稿时长

12 weeks

期刊介绍： The Lancet Healthy Longevity, a gold open-access journal, focuses on clinically-relevant longevity and healthy aging research. It covers early-stage clinical research on aging mechanisms, epidemiological studies, and societal research on changing populations. The journal includes clinical trials across disciplines, particularly in gerontology and age-specific clinical guidelines. In line with the Lancet family tradition, it advocates for the rights of all to healthy lives, emphasizing original research likely to impact clinical practice or thinking. Clinical and policy reviews also contribute to shaping the discourse in this rapidly growing discipline.