BMJ  2008;336:134-138 (19 January), doi:10.1136/bmj.39408.481898.BE (published 2 January 2008)

Research

Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study

¹ Alzheimer Centre Nijmegen, Department of Occupational Therapy 897, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, Netherlands, ² Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, ³ Alzheimer Centre Nijmegen, Department of Quality of Care Research, Radboud University Nijmegen Medical Centre, ⁴ Department of Rehabilitation Medicine, Free University Medical Centre Amsterdam, Amsterdam, Netherlands, ⁵ Division of Geriatric Epidemiology, Neurotec Department, Karolinska Institute, Stockholm, Sweden, ⁶ Alzheimer Centre Nijmegen, Department of Geriatrics 925, Radboud University Nijmegen Medical Centre

Objective To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint.

Design Cost effectiveness study alongside a single blind randomised controlled trial.

Setting Memory clinic, day clinic of a geriatrics department, and participants’ homes.

Patients 135 patients aged 65 with mild to moderate dementia living in the community and their primary care givers.

Intervention 10 sessions of occupational therapy over five weeks, including cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision.

Main outcome measures Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment (that is, a combined patient and care giver outcome measure of clinically relevant improvement on process, performance, and competence scales) at three months after randomisation. Bootstrap methods used to determine confidence intervals for these measures.

Results The intervention cost 1183 (£848, $1738) (95% confidence interval 1128 (£808, $1657) to 1239 (£888, $1820)) per patient and primary care giver unit at three months. Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were 1748 (£1279, $2621) lower in the intervention group, with the main cost savings in informal care. There was a significant difference in proportions of successful treatments of 36% at three months. The number needed to treat for successful treatment at three months was 2.8 (2.7 to 2.9).

Conclusions Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective, especially in terms of informal care giving.

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