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Effectiveness of a continuum of care using brief and partial hospitalization for agitated dementia patients |
Mintzer J E, Colenda C, Waid L R, Lewis L, Meeks A, Stuckey M, Bachman D L, Saladin M, Sampson R R |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology A continuum of care using brief and partial hospitalizationfor agitated dementia patients.
Economic study type Cost-effectiveness analysis.
Study population Patients with different ethnic backgrounds diagnosed with both dementia and agitation. Patient had a mean (+
Setting Hospital. The study was carried out in USA.
Dates to which data relate Data for the effectiveness analysis were collected during the last six months of 1992 and the last six months of 1993. Price dates were not given.
Source of effectiveness data The estimate for the final outcome was derived from a single study.
Link between effectiveness and cost data The costing was undertaken prospectively on the same patient sample.
Study sample Power calculations were not used to determine the sample size. A total of 180 patients were sampled, 68 patients were enrolled in the 21-day programme and 112 patients were from the continuum-of-care programme.
Study design The study was a non-randomized controlled trial with historical controls. The period of follow-up was 1 year. The loss to follow-up was not stated.
Analysis of effectiveness The analysis of the clinical study was based on intention to treat. The primary health outcome used was an agitated behaviour score. The instrument to valuate this data was the patient's score on the Cohen-Manfield Agitation Inventory. The groups were shown to be comparable in terms of prognostic features and sociodemographic variables.
Effectiveness results Agitated behaviour decreased by at least 30% for 74 (66%) of the patients in the continuum-of-care group and by 33% for 33 (49%) in the inpatient group (p <0.01).
Clinical conclusions A statistically significant reduction in agitation was found for patients treated in both programmes, with no significant differences in outcome between programmes.
Measure of benefits used in the economic analysis Since the effectiveness analysis showed no difference in effectiveness between the intervention and the comparator, the economic analysis was based on the difference of costs only.
Direct costs Only health care costs were considered. It was not clear whether costs were discounted. Quantities and costs were not reported separately. The estimation of quantities and costs was based on actual data. The hospital costs included the cost for a day of inpatient hospitalization and for a day of partial hospitalization. Price dates were not given.
Sensitivity analysis Sensitivity analysis was not carried out.
Estimated benefits used in the economic analysis Cost results The cost of the continuum-of care programme was $9,600 per patient and the cost of the inpatient programme was $18,558. It was not clear whether costs were discounted.
Synthesis of costs and benefits The continuum-of-care programme was shown to be the weakly dominant strategy. The continuum-of-care programme was significantly more cost-effective than the inpatient programme, with an approximately threefold difference in CMAI total score per $1,000.
Authors' conclusions If the basic elements of a clinical programme are preserved, successful outcome can be achieved without expensive and extended hospitalization.
CRD COMMENTARY - Selection of comparators The reason for the choice of the comparator, a 21-day inpatient programme, was clear since it was a common treatment strategy.
Validity of estimate of measure of benefit The authors recognised that the study was not a randomized controlled trial thus the possibility of systematic bias in the sample could not be excluded.
Validity of estimate of costs Due to the lack of adequate information about the cost estimation methods used in the study, it is impossible to judge whether any important cost items were omitted. A societal perspective would have considered indirect costs for caregivers as well.
Other issues As the study lacked randomisation and sensitivity analysis, the results need to be treated with some caution. The issue of generalisability to other settings orcountries was not addressed. No comparisons with other studies were made.
Bibliographic details Mintzer J E, Colenda C, Waid L R, Lewis L, Meeks A, Stuckey M, Bachman D L, Saladin M, Sampson R R. Effectiveness of a continuum of care using brief and partial hospitalization for agitated dementia patients. Psychiatric Services 1997; 48(11): 1435-1439 Indexing Status Subject indexing assigned by NLM MeSH Activities of Daily Living /psychology; Aged; Aged, 80 and over; Aggression /psychology; Behavior Therapy; Combined Modality Therapy; Continuity of Patient Care; Day Care, Medical; Dementia /diagnosis /psychology /therapy; Female; Humans; Length of Stay; Male; Neuropsychological Tests; Outcome Assessment (Health Care); Patient Care Team; Psychomotor Agitation /diagnosis /psychology /therapy; Psychotherapy, Brief; South Carolina AccessionNumber 21997001500 Date bibliographic record published 31/12/1998 Date abstract record published 31/12/1998 |
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