Cost effectiveness of non-drug interventions that reduce nursing home admissions for people living with dementia

Eric Jutkowitz; Laura T. Pizzi; Peter Shewmaker; Fernando Alarid-Escudero; Gary Epstein-Lubow; Katherine M. Prioli; Joseph E. Gaugler; Laura N. Gitlin

doi:10.1002/alz.12964

Cost effectiveness of non-drug interventions that reduce nursing home admissions for people living with dementia

Eric Jutkowitz, Laura T. Pizzi, Peter Shewmaker, Fernando Alarid-Escudero, Gary Epstein-Lubow, Katherine M. Prioli, Joseph E. Gaugler, Laura N. Gitlin

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

INTRODUCTION: Six million Americans live with Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD), a major health-care cost driver. We evaluated the cost effectiveness of non-pharmacologic interventions that reduce nursing home admissions for people living with AD/ADRD. METHODS: We used a person-level microsimulation to model the hazard ratios (HR) on nursing home admission for four evidence-based interventions compared to usual care: Maximizing Independence at Home (MIND), NYU Caregiver (NYU); Alzheimer's and Dementia Care (ADC); and Adult Day Service Plus (ADS Plus). We evaluated societal costs, quality-adjusted life years and incremental cost-effectiveness ratios. RESULTS: All four interventions cost less and are more effective (i.e., cost savings) than usual care from a societal perspective. Results did not materially change in 1-way, 2-way, structural, and probabilistic sensitivity analyses. CONCLUSION: Dementia-care interventions that reduce nursing home admissions save societal costs compared to usual care. Policies should incentivize providers and health systems to implement non-pharmacologic interventions.

Original language	English (US)
Pages (from-to)	3867-3893
Number of pages	27
Journal	Alzheimer's and Dementia
Volume	19
Issue number	9
DOIs	https://doi.org/10.1002/alz.12964
State	Published - Sep 2023

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Publisher Copyright:
© 2023 the Alzheimer's Association.

Keywords

caregiving
cost effectiveness
dementia
non-drug interventions

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural

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10.1002/alz.12964

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abstract = "INTRODUCTION: Six million Americans live with Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD), a major health-care cost driver. We evaluated the cost effectiveness of non-pharmacologic interventions that reduce nursing home admissions for people living with AD/ADRD. METHODS: We used a person-level microsimulation to model the hazard ratios (HR) on nursing home admission for four evidence-based interventions compared to usual care: Maximizing Independence at Home (MIND), NYU Caregiver (NYU); Alzheimer's and Dementia Care (ADC); and Adult Day Service Plus (ADS Plus). We evaluated societal costs, quality-adjusted life years and incremental cost-effectiveness ratios. RESULTS: All four interventions cost less and are more effective (i.e., cost savings) than usual care from a societal perspective. Results did not materially change in 1-way, 2-way, structural, and probabilistic sensitivity analyses. CONCLUSION: Dementia-care interventions that reduce nursing home admissions save societal costs compared to usual care. Policies should incentivize providers and health systems to implement non-pharmacologic interventions.",

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note = "Publisher Copyright: {\textcopyright} 2023 the Alzheimer's Association.",

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AU - Pizzi, Laura T.

AU - Shewmaker, Peter

AU - Alarid-Escudero, Fernando

AU - Epstein-Lubow, Gary

AU - Prioli, Katherine M.

AU - Gaugler, Joseph E.

AU - Gitlin, Laura N.

PY - 2023/9

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N2 - INTRODUCTION: Six million Americans live with Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD), a major health-care cost driver. We evaluated the cost effectiveness of non-pharmacologic interventions that reduce nursing home admissions for people living with AD/ADRD. METHODS: We used a person-level microsimulation to model the hazard ratios (HR) on nursing home admission for four evidence-based interventions compared to usual care: Maximizing Independence at Home (MIND), NYU Caregiver (NYU); Alzheimer's and Dementia Care (ADC); and Adult Day Service Plus (ADS Plus). We evaluated societal costs, quality-adjusted life years and incremental cost-effectiveness ratios. RESULTS: All four interventions cost less and are more effective (i.e., cost savings) than usual care from a societal perspective. Results did not materially change in 1-way, 2-way, structural, and probabilistic sensitivity analyses. CONCLUSION: Dementia-care interventions that reduce nursing home admissions save societal costs compared to usual care. Policies should incentivize providers and health systems to implement non-pharmacologic interventions.

AB - INTRODUCTION: Six million Americans live with Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD), a major health-care cost driver. We evaluated the cost effectiveness of non-pharmacologic interventions that reduce nursing home admissions for people living with AD/ADRD. METHODS: We used a person-level microsimulation to model the hazard ratios (HR) on nursing home admission for four evidence-based interventions compared to usual care: Maximizing Independence at Home (MIND), NYU Caregiver (NYU); Alzheimer's and Dementia Care (ADC); and Adult Day Service Plus (ADS Plus). We evaluated societal costs, quality-adjusted life years and incremental cost-effectiveness ratios. RESULTS: All four interventions cost less and are more effective (i.e., cost savings) than usual care from a societal perspective. Results did not materially change in 1-way, 2-way, structural, and probabilistic sensitivity analyses. CONCLUSION: Dementia-care interventions that reduce nursing home admissions save societal costs compared to usual care. Policies should incentivize providers and health systems to implement non-pharmacologic interventions.

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Cost effectiveness of non-drug interventions that reduce nursing home admissions for people living with dementia

Abstract

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