Cost-Utility Analysis of Adapted Problem Adaptation Therapy for Depression in Mild to Moderate Dementia Caused by Alzheimer's Disease: Pathfinder Randomized Controlled Trial

OBJECTIVES: Depression is common in people with dementia and impacts quality of life negatively. This paper aims to evaluate the cost-effectiveness of an intervention for depression in mild and moderate dementia caused by Alzheimer’s disease over 12 months (PATHFINDER trial) from both the health and social care and societal perspectives.

METHODS: 336 participants were randomised to receive the adapted PATH intervention in addition to treatment as usual (TAU) (n=168) or TAU alone (n=168). Health and social care resource use were collected using the Client Service Receipt Inventory and health-related quality-of-life data using the EQ-5D-5L instrument at baseline, 3-, 6-, and 12-months follow-up points. Principal analysis comprised quality-adjusted life-years (QALYs) calculated from the participant responses to the EQ-5D-5L instrument.

RESULTS: The mean cost of the adapted PATH intervention was estimated at £1,141 per PATHFINDER participant. From a health and social care perspective, the mean difference in costs between the adapted PATH and control arm at 12 months was -£74 (95% CI: -£1,942 to £1,793) and from the societal perspective was -£671 (95% CI: -£9,144 to £7,801). The mean difference in QALYs was 0.027 (95% CI: -0.004 to 0.059). At £20,000 per QALY gained threshold there were 74% and 68% probabilities of adapted PATH being cost-effective from the health and social care and societal perspective, respectively.

CONCLUSIONS: The addition of the adapted PATH intervention to TAU for people with dementia and depression generated cost savings alongside a higher quality of life compared to TAU alone; however, the improvements in costs and QALYs were not statistically significant. As policymakers focus on health and social care costs, the findings reported here suggest that using an intervention similar to ours for treating depression in people with dementia could be cost-effective if a broader focus on health outcomes is adopted.