plans and strategies that aim to improve well-being and reduce ill-being in the person
with dementia. These strategies are then implemented and monitored regularly. The
process has merit and is gaining worldwide popularity. However, the cost of
implementing DCM may be prohibitive for aged care providers who wish to employ
the process to improve care quality, as it is labour intensive, training is costly and full
supervision is required from an accredited DCM trainer.[9, 10]
The CARES trial, the first to subject PCC and DCM to a randomised controlled trial,
concluded that both PCC and DCM reduced agitation and improved quality of life
relative to UC. However, it is unclear whether this result is adequate to justify
economically generalised adoption of either technique. Economic evaluation is a
potentially useful tool in this debate as it seeks to quantify both the benefits and costs
of the approaches under consideration with the aim of identifying which intervention
represents the better use of scarce societal resources. Generally, this means estimating
an Incremental Cost-Effectiveness Ratio (ICER). If a new intervention is being
compared with an existing intervention, the ICER estimated in the following way:
ICER =
Cost
New
- Cost
Comparator
Effectiveness New - Effectiveness Comparator
The ICER can be interpreted as the cost of a one-point improvement in whichever
outcome measure is considered to best represent the effect of the intervention. In the
case of DCM, PCC and Usual Care (UC), the ICERs of DCM and PCC can be
contrasted with that of UC; it is then possible to compare DCM and PCC if the results
are likely to further inform the decision-making process. For example, it would be
appropriate to make such a comparison if both approaches are equally effective but
one costs less in total. In this situation, cost-effectiveness analysis would identify the
extra resources available for use in other areas of the healthcare sector. The aims of
the economic evaluation reported here were to estimate both the costs and
effectiveness of DCM and PCC relative to UC within the CARES trial; to contrast the
aggregate costs and outcomes across the three interventions and attempt to reach
conclusions about the optimal approach; and to present the limitations and
uncertainties surrounding these conclusions.
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