Read the full case study for 'Interventions beyond medicine for dementia: economic evidence' here (PDF)
Michela Tinelli, Martin Knapp, Adelina Comas-Herrera, Danielle Guy 2019
An introduction to economic evaluation in occupational therapy: cost-effectiveness of pre-discharge home visits after stroke (HOVIS)
Sampson C, James M, Whitehead P, et al British Journal of Occupational Therapy, 77, 330-335. 2014
Introduction: Occupational therapy interventions, such as home visits, have been identified as being resource-intensive, but cost-effectiveness analyses are rarely, if ever, carried out. The authors sought to estimate the cost-effectiveness of occupational therapy home visits after stroke, as part of a feasibility study, and to demonstrate the value and methods of economic evaluation. Method: The authors completed a cost-effectiveness analysis of pre-discharge occupational therapy home visits after stroke compared with a hospital-based interview, carried out alongside a feasibility randomised controlled trial. Their primary outcome was quality-adjusted life years. Full cost and outcome data were available for 65 trial participants. Findings: The mean total cost of a home visit was found to be £183, compared with £75 for a hospital interview. Home visits are shown to be slightly more effective, resulting in a cost per quality-adjusted life year of just over £20,000. Conclusion: The author’s analysis is the only economic evaluation of this intervention to date. Home visits are shown to be more expensive and more effective than a hospital-based interview, but the results are subject to a high level of uncertainty and should be treated as such. Further economic evaluations in this field are encouraged.
Dementia care costs and outcomes: a systematic review
Knapp M, Iemmi V, Romeo R International Journal of Geriatric Psychiatry, 28:, 551-556. 2013
We reviewed evidence on the cost-effectiveness of prevention, care and treatment strategies in relation to dementia.
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.
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.
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.
Dementia: Assessment, Management and Support for People Living with Dementia and their Carers [NG97]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2018
This guideline covers diagnosing and managing dementia (including Alzheimer’s disease). It aims to improve care by making recommendations on training staff and helping carers to support people living with dementia.
This guideline includes recommendations on:
• involving people living with dementia in decisions about their care
• assessment and diagnosis
• interventions to promote cognition, independence and wellbeing
• pharmacological interventions
• managing non-cognitive symptoms
• supporting carers
• staff training and education
Who is it for?
• Healthcare and social care professionals caring for and supporting people living with dementia
• Commissioners and providers of dementia health and social care services
• Housing associations, private and voluntary organisations contracted by the NHS or social services to provide care for people living with dementia
• People living with dementia, their families and carers
Related NICE guideline:
Appendix J:Health Economics Authors not listed
Living, Not Existing: Putting Prevention at the Heart of Care for Older People in Wales
Royal College of Occupational Therapists Royal College of Occupational Therapists, London. 2017
This report focuses on the important contribution that occupational therapists can make to support further integration of health and social care in Wales. It looks at the role of occupational therapy in helping older people to remain independent and live in their own communities for as long as possible, preventing or delaying the need for expensive care long-term. The report focuses on three key areas: prevention or delaying the need for care and support; helping older people to remain in their communities; and ensuring equality of access to occupational therapy. It provides recommendations to improve the design and delivery of services and examples of best practice and individual case studies to how occupational therapists can contribution to integrated, person-centred services. These include for occupational therapists to work more closely with general practitioners, take on leadership roles to provide expertise to community providers on the development of person and community centred services; and the development of formal partnership agreements across local housing, health and social care sectors to ensure all older people have access to occupational therapy services.
Mental Health Problems in People with Learning Disabilities: Prevention, Assessment and Management [NG54]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2016
This guideline covers preventing, assessing and managing mental health problems in people with learning disabilities in all settings (including health, social care, education, and forensic and criminal justice). It aims to improve assessment and support for mental health conditions, and help people with learning disabilities and their families and carers to be involved in their care.
This guideline includes recommendations on:
organising and delivering care
involving people in their care
prevention, including social, physical environment and occupational interventions
annual GP health checks
psychological interventions, and how to adapt these for people with learning disabilities
prescribing, monitoring and reviewing pharmacological interventions
Who is it for?
Social care practitioners
Commissioners and service providers
People with learning disabilities and their families and carers
Related NICE guideline:
Appendix S: Health economic evidence –economic profiles Authors not listed
The effectiveness of local authority social services' occupational therapy for older people in Great Britain: a critical literature review
Boniface GE, Mason M, Macintyre J, et al British Journal of Occupational Therapy, 76, 538-547. 2013
This literature review systematically selected, critically appraised, and thematically synthesized the post 2000 published and unpublished evidence on the effectiveness and cost effectiveness of occupational therapy interventions for older people in social care services. Identified themes established: the localized nature of social care services for older people; organizational and policy impacts on services, and factors influencing effectiveness and cost effectiveness. Although occupational therapists are increasingly involved in rehabilitation and reablement, there is a continuing focus on equipment and adaptations provision. A high level of service user satisfaction was identified, once timely occupational therapy services were received. Overall, occupational therapy in social care is perceived as effective in improving quality of life for older people and their carers, and cost effective in making savings for other social and healthcare services. However, the complex nature of social care services makes it difficult to disaggregate the effectiveness of occupational therapy from other services.
NIHR School for
Social Care Research