Tuesday, July 16, 2024

Collaborative Dementia Care Management Demonstrates Long-Term Benefits: A Clinical Trial Analysis

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The implementation of Collaborative Dementia Care Management (CDCM) has shown promising outcomes in a recent study, which evaluated its effectiveness and cost-efficiency over a 36-month period. Conducted in Germany, this clinical trial highlights the potential of CDCM to significantly enhance the quality of life for patients and reduce caregiver burden, suggesting a shift in health policy to incorporate such interventions into routine care.

Study Design and Participants

A clinical trial was conducted from January 1, 2012, to December 31, 2014, with follow-up until March 31, 2018. This study evaluated 308 dementia patients aged 70 and above, living at home, who were divided into two groups: one receiving CDCM and the other receiving usual care. CDCM involved a comprehensive needs assessment and personalized interventions managed by specially trained nurses in collaboration with general practitioners (GPs) and healthcare stakeholders over six months.

Key Outcomes and Measures

The primary outcomes measured included neuropsychiatric symptoms, caregiver burden, health-related quality of life (HRQOL), and cost-effectiveness over 36 months. The analysis revealed that patients in the CDCM group had significantly fewer behavioral and psychological symptoms, improved mental health, and reduced caregiver burden compared to those receiving usual care. Interestingly, market access considerations arise from the finding that CDCM did not significantly increase costs, suggesting it could be an economically viable option for broader healthcare implementation.

No differences were observed between the groups in terms of antidementia drug usage, overall HRQOL, physical health, or use of potentially inappropriate medication. However, the CDCM group gained quality-adjusted life years (QALYs) without incurring significant additional costs, translating to a cost-effectiveness ratio of €3186 per QALY.

Concrete Inferences

– CDCM significantly reduces neuropsychiatric symptoms and caregiver burden.
– Improved mental health outcomes were noted in the CDCM group.
– Cost-effectiveness of CDCM was more favorable for patients living alone compared to those living with caregivers.
– The potential for broader market access is supported by the lack of significant cost increase associated with CDCM implementation.

The trial’s findings suggest that CDCM could become a priority in health policy, given its association with improved outcomes for patients and caregivers without substantial additional costs. The economic viability highlighted by the study underlines the importance of making such interventions more accessible within the healthcare market.

Overall, the study underscores the value of integrating CDCM into routine dementia care to achieve long-term benefits, advocating for its inclusion in health policy initiatives to enhance patient and caregiver well-being sustainably.

Original Article:

JAMA Netw Open. 2024 Jul 1;7(7):e2419282. doi: 10.1001/jamanetworkopen.2024.19282.

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IMPORTANCE: Long-term evidence for the effectiveness and cost-effectiveness of collaborative dementia care management (CDCM) is lacking.

OBJECTIVE: To evaluate whether 6 months of CDCM is associated with improved patient clinical outcomes and caregiver burden and is cost-effective compared with usual care over 36 months.

DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified secondary analysis of a general practitioner (GP)-based, cluster randomized, 2-arm clinical trial conducted in Germany from January 1, 2012, to December 31, 2014, with follow-up until March 31, 2018. Participants were aged 70 years or older, lived at home, and screened positive for dementia. Data were analyzed from March 2011 to March 2018.

INTERVENTION: The intervention group received CDCM, comprising a comprehensive needs assessment and individualized interventions by nurses specifically qualified for dementia care collaborating with GPs and health care stakeholders over 6 months. The control group received usual care.

MAIN OUTCOMES AND MEASURES: Main outcomes were neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]), caregiver burden (Berlin Inventory of Caregivers’ Burden in Dementia [BIZA-D]), health-related quality of life (HRQOL, measured by the Quality of Life in Alzheimer Disease scale and 12-Item Short-Form Health Survey [SF-12]), antidementia drug treatment, potentially inappropriate medication, and cost-effectiveness (incremental cost per quality-adjusted life year [QALY]) over 36 months. Outcomes between groups were compared using multivariate regression models adjusted for baseline scores.

RESULTS: A total of 308 patients, of whom 221 (71.8%) received CDCM (mean [SD] age, 80.1 [5.3] years; 142 [64.3%] women) and 87 (28.2%) received usual care (mean [SD] age, 79.2 [4.5] years; 50 [57.5%] women), were included in the clinical effectiveness analyses, and 428 (303 [70.8%] CDCM, 125 [29.2%] usual care) were included in the cost-effectiveness analysis (which included 120 patients who had died). Participants receiving CDCM showed significantly fewer behavioral and psychological symptoms (adjusted mean difference [AMD] in NPI score, -10.26 [95% CI, -16.95 to -3.58]; P = .003; Cohen d, -0.78 [95% CI, -1.09 to -0.46]), better mental health (AMD in SF-12 Mental Component Summary score, 2.26 [95% CI, 0.31-4.21]; P = .02; Cohen d, 0.26 [95% CI, -0.11 to 0.51]), and lower caregiver burden (AMD in BIZA-D score, -0.59 [95% CI, -0.81 to -0.37]; P < .001; Cohen d, -0.71 [95% CI, -1.03 to -0.40]). There was no difference between the CDCM group and usual care group in use of antidementia drugs (adjusted odds ratio, 1.91 [95% CI, 0.96-3.77]; P = .07; Cramér V, 0.12) after 36 months. There was no association with overall HRQOL, physical health, or use of potentially inappropriate medication. The CDCM group gained QALYs (0.137 [95% CI, 0.000 to 0.274]; P = .049; Cohen d, 0.20 [95% CI, -0.09 to 0.40]) but had no significant increase in costs (437€ [-5438€ to 6313€] [US $476 (95% CI, -$5927 to $6881)]; P = .87; Cohen d, 0.07 [95% CI, -0.14 to 0.28]), resulting in a cost-effectiveness ratio of 3186€ (US $3472) per QALY. Cost-effectiveness was significantly better for patients living alone (CDCM dominated, with lower costs and more QALYs gained) than for those living with a caregiver (47 538€ [US $51 816] per QALY).

CONCLUSIONS AND RELEVANCE: In this secondary analysis of a cluster randomized clinical trial, CDCM was associated with improved patient, caregiver, and health system-relevant outcomes over 36 months beyond the intervention period. Therefore, it should become a health policy priority to initiate translation of CDCM into routine care.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01401582.

PMID:38967926 | DOI:10.1001/jamanetworkopen.2024.19282

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