Economic Implications of Different Implementation Strategies for Collaborative Dementia Care Management in Terms of Patient Characteristics, Unmet Needs, and Cost-Effectiveness

OBJECTIVES: To compare the implementation of collaborative dementia care management (cDCM) across two settings regarding patients' characteristics, unmet needs, and the impact on health-related quality of life (HRQoL) and costs (cost-effectiveness).

METHODS: This analysis was based on data from the DCM:IMPact study, implementing cDCM in a physician network (n=22 practices) and two day care centers (DCC) for community-dwelling persons with dementia over six months. Participants completed comprehensive assessments at baseline and six months after, soliciting sociodemographic and clinical characteristics, unmet needs, HRQoL and healthcare resource utilization. Patient characteristics and unmet needs were analyzed descriptively, and the impact of cDCM on costs and HRQoL was assessed using multivariable regression models.

RESULTS: Patients from the physician network (n=46) exhibited more pronounced neuropsychiatric symptoms (NPI mean score 14 vs. 10, p=0.075), were more frequently diagnosed with dementia (76% vs. 56%, p=0.040), had less likely a care level (63% vs. 91%, p≤0.001) and had more unmet needs (12.8 vs. 11.0, p≤0.001), especially for social care services than DCC patients (n=57). The adjusted means indicated that cDCM implemented in the physician network was more effective (EQ-5D-5L; 0.061; 95% CI: -0.032 – 0.153) and less costly (-5,950€; 95% CI -8,415€ – -3,485€) than implemented in DCC.

CONCLUSIONS: Patients and the healthcare system benefit more when cDCM is implemented in physician networks. However, patient characteristics indicated two samples with specific conditions and various unmet needs using different ways of accessing healthcare, demonstrating the need for cDCM in both settings, which must be considered when implementing cDCM to integrate the respective sectors efficiently.