Clinical and cost effectiveness of services for early diagnosis and intervention in dementia
Clinical and cost effectiveness of services for early diagnosis and intervention in dementia
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DOI：
10.1002/gps.2191
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发表时间：
2009-07-01
影响因子：
4
通讯作者：
Wittenberg, Raphael
中科院分区：
文献类型：
--
作者：
Banerjee, Sube;Wittenberg, Raphael
本文分析了委托记忆服务进行痴呆早期诊断和干预的成本和收益。方法一个模型被开发，以检查潜在的公共和私人储蓄与延迟入院护理之家在英国由于记忆服务的委托。在英国，这项新服务每年将额外花费约2.2亿英镑。如果10%的养老院入住被阻止，预计到第10年将节省大约1.2亿英镑的公共支出（社会护理）和1.25亿英镑的私人支出（服务使用者及其家庭），总计2.45亿英镑。在减少20%的情况下，每年的成本将在大约6年内被节省下来的公共资金所抵消。在10年内，所有痴呆症患者都将有机会接受新的服务。每人每年获得0.01至0.02个质量年，就足以使这项服务具有成本效益（以正净现值计算）。这些相对较小的改进似乎很有可能实现。这些分析表明，这项服务只需要适度提高痴呆症患者的平均生活质量，再加上将痴呆症患者从住院护理中转移10%，就具有成本效益。然后，根据所讨论的假设并从社会的角度来看，预期的收益将证明公共支出的净增加是合理的。从生活质量和总体成本效益的角度来看，这一模型为发展早期识别和治疗痴呆症的全国性服务提供了辩论支持。版权所有John Wiley & Sons， Ltd. 2009
Background This paper analyses the costs and benefits of commissioning memory services for early diagnosis and intervention for dementia.Method A model was developed to examine potential public and private savings associated with delayed admissions to care homes in England as a result of the commissioning of memory services.Findings The new services would cost around 220 pound million extra per year nationally in England. The estimated savings if 10% of care home admissions were prevented would by year 10 be around 120 pound million in public expenditure (social care) and 125 pound million in private expenditure (service users and their families), a total of 245 pound million. Under a 20% reduction, the annual cost would within around 6 years be offset by the savings to public funds alone. In 10 years all people with dementia will have had the chance to be seen by the new services. A gain of between 0.01 and 0.02 QALYs per person year would be sufficient to tender the service cost-effective (in terms of positive net present value). These relatively small improvements seem very likely to be achievable.Interpretation These analyses suggest that the service need only achieve a modest increase in average quality of life of people with dementia, plus a 10% diversion of people with dementia from residential care, to be cost-effective. The net increase in public expenditure would then, on the assumptions discussed and from a societal perspective, be justified by the expected benefits. This modelling presents for debate support for the development of nationwide services for the early identification and treatment of dementia in terms of quality of life and overall cost-effectiveness. Copyright (C) 2009 John Wiley & Sons, Ltd.