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Results of a Randomized Controlled Trial

Claire A. G. Wolfs, PhD; Carmen D. Dirksen, PhD; Alfons Kessels, MD, MSc; Johan L. Severens, PhD; Frans R. J. Verhey, PhD, MD

Arch Gen Psychiatry. 2009;66(3):313-323.

Context  Because of the increasing number of elderly people with dementia, the costs of dementia and dementia care are expected to grow rapidly in the coming decades. Cost-effectiveness results are relevant for decision making about new strategies in dementia care.

Objective  To evaluate the cost-effectiveness of an integrated multidisciplinary diagnostic facility for diagnosing dementia in ambulatory psychogeriatric patients.

Design  Randomized controlled trial with an economic evaluation component.

Setting  The Maastricht Evaluation of a Diagnostic Intervention for Cognitively Impaired Elderly, Maastricht University Hospital, Maastricht, the Netherlands.

Patients  A total of 137 patients who received care in the multidisciplinary diagnostic facility and 93 who received usual care.

Main Outcome Measures  Quality-adjusted life-years (QALYs) as the main outcome measure and cognition and behavioral problems as secondary outcome measures.

Results  Compared with patients receiving usual care, patients who visited the diagnostic facility gained a mean 0.05 QALY at the extra cost of 65. The incremental cost per QALY amounted to 1267. This point estimate lies beneath commonly accepted thresholds and is within an acceptable range of uncertainty. With regard to the secondary analyses, cost-effectiveness results showed a substantial amount of uncertainty and were therefore indecisive.

Conclusion  On the basis of the main cost-per-QALY analysis, the use of the integrated multidisciplinary diagnostic facility is cost-effective for the diagnosis and management of dementia in ambulatory patients.

Trial Registration  clinicaltrials.gov Identifier: NCT00402311

Author Affiliations: Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands (Drs Wolfs, Dirksen, Kessels, and Severens); and Departments of Psychiatry and Neuropsychology (Drs Wolfs and Verhey) and Health Organization, Policy and Economics (Dr Severens), Maastricht University, Maastricht.

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