Cognitive Stimulation Therapy for People with Dementia: Cost-effectiveness analysis

Bangor University, Bangon, Wales, United Kingdom
The British Journal of Psychiatry (Impact Factor: 7.99). 07/2006; 188(6):574-80. DOI: 10.1192/bjp.bp.105.010561
Source: PubMed


Psychological therapy groups for people with dementia are widely used, but their cost-effectiveness has not been explored.
To investigate the cost-effectiveness of an evidence-based cognitive stimulation therapy (CST) programme for people with dementia as part of a randomised controlled trial.
A total of 91 people with dementia, living in care homes or the community, received a CST group intervention twice weekly for 8 weeks; 70 participants with dementia received treatment as usual. Service use was recorded 8 weeks before and during the 8-week intervention and costs were calculated. A cost-effectiveness analysis was conducted with cognition as the primary outcome, and quality of life as the secondary outcome. Cost-effectiveness acceptability curves were plotted.
Cognitive stimulation therapy has benefits for cognition and quality of life in dementia, and costs were not different between the groups. Under reasonable assumptions, there is a high probability that CST is more cost-effective than treatment as usual, with regard to both outcome measures.
Cognitive stimulation therapy for people with dementia has effectiveness advantages over, and may be more cost-effective than, treatment as usual.

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Available from: Anita Patel, Feb 17, 2015
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    • "In phase two of the framework, the program was piloted,8 further modified, and extensively evaluated in a large and randomized controlled trial.2 The results showed that the CST group improved significantly in the main outcome measures of cognition and quality of life, that the intervention was cost effective, and that it compared favorably with the pharmaceutical intervention of cholinesterase inhibitors for Alzheimer’s disease in terms of numbers needed to treat.2,9 The basic CST program includes 14 sessions of 45 minutes each, occurring twice a week for 7 weeks. "
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    ABSTRACT: Cognitive stimulation therapy (CST) has been shown to be an useful and cost effective intervention that increases cognition and quality of life of people with mild to moderate dementia. It is increasing in popularity in the UK and worldwide, and a number of research teams have examined its effectiveness in other contexts and cultures. However, it is necessary to develop clear evidence-based guidelines for cultural modification of the intervention. This article describes a community-based developmental approach to adapt CST to different cultures, following the five phases of the formative method for adapting psychotherapy (FMAP), an approach that involves collaborating with service users as a first step to generate and support ideas for therapy adaptation. Examples based on clinical and practical experience are presented, along with suggestions for applying these changes in different cultural contexts.
    Clinical Interventions in Aging 06/2014; 9:1003-7. DOI:10.2147/CIA.S61849 · 2.08 Impact Factor
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    • "Considering all these, providing services for people with dementia has been recognized as a major public health priority in the UK and worldwide (Brookmeyer, Gray & Kawas, 1998; Banerjee, Willis, Mathews, Contell, Chan & Murray, 2007). There is an increasingly higher recognition in the literature, related to the fact that, psychosocial interventions make an essential contribution in dementia care and they are effective also in terms of costs (Knapp et al., 2006; Vasse et al., 2012). Most of these psychosocial interventions aim to improve: cognitive abilities, behavior, mood or quality of life. "
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    ABSTRACT: There is a high recognition of the fact that psychosocial interventions make an essential contribution in dementia care. However, the evidence for specific psychosocial interventions are mixed and limited yet. Therefore, we performed a meta-analysis of the relevant literature, to investigate the effectiveness of psychosocial interventions focused on improvements in cognition, behavior, mood and quality of life. To select the 10 studies included in the meta-analysis, we conducted an extensive search in the following databases: MEDLINE, PsychINFO, EBSCO, WEB OF SCIENCE. The results we obtained show that psychosocial interventions in dementia for cognitive abilities are effective, even if the effect size is low.
    Procedia - Social and Behavioral Sciences 04/2014; 127:591-594. DOI:10.1016/j.sbspro.2014.03.316
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    • "good cognitive functioning and as secondary prevention for older people with mild-to-moderate dementia (Medical Advisory Secretariat, 2008). Literature reviews by the Ministry of Health and Long-Term Care in Ontario (Medical Advisory Secretariat, 2008) and the Belgian Health Care Knowledge Centre (Hulstaert et al., 2009) identified only one randomised controlled trial evaluating the cost-effectiveness of a CST programme as secondary prevention (Knapp et al., 2006). In this English study, CST was offered to people with mild-tomoderate dementia in group sessions run in care homes and day centres twice a week for 8 weeks. "
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    ABSTRACT: Objective: We reviewed evidence on the cost-effectiveness of prevention, care and treatment strategies in relation to dementia. Methods: We performed a systematic review of available literature on economic evaluations of dementia care, searching key databases and websites in medicine, social care and economics. Literature reviews were privileged, and other study designs were included only to fill gaps in the evidence base. Narrative analysis was used to synthesise the results. Results: We identified 56 literature reviews and 29 single studies offering economic evidence on dementia care. There is more cost-effectiveness evidence on pharmacological therapies than other interventions. Acetylcholinesterase inhibitors for mild-to-moderate disease and memantine for moderate-to-severe disease were found to be cost-effective. Regarding non-pharmacological treatments, cognitive stimulation therapy, tailored activity programme and occupational therapy were found to be more cost-effective than usual care. There was some evidence to suggest that respite care in day settings and psychosocial interventions for carers could be cost-effective. Coordinated care management and personal budgets held by carers have also demonstrated cost-effectiveness in some studies. Conclusion: Five barriers to achieving better value for money in dementia care were identified: the scarcity and low methodological quality of available studies, the difficulty of generalising from available evidence, the narrowness of cost measures, a reluctance to implement evidence and the poor coordination of health and social care provision and financing.
    International Journal of Geriatric Psychiatry 06/2013; 28(6). DOI:10.1002/gps.3864 · 2.87 Impact Factor
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