OBJECTIVES: Six million American live with dementia. Although people living with dementia generally want to age in their community, they have a high risk of moving to a nursing home. In randomized trials, psychosocial interventions reduce the risk of people living with dementia transitioning to a nursing home, but the cost-effectiveness of these interventions is unknown.

METHODS: We used an evidence-based mathematical model and data from the National Alzheimer’s Coordinating Center and Medicare to simulate a place of residence (community or nursing home) for people living with dementia. Our model also predicts time caregiving, health care costs, and quality-adjusted life-years (QALYs). We modeled the reduction in nursing home rate (i.e., hazard ratio (HR) treatment effect) identified from four trials of non-drug interventions for people living with dementia and their caregiver. Specifically, we modeled Maximizing Independence at Home (MIND; HR 0.63; 95% CI: 0.42, 0.94; 18-month effect); 2) NYU Caregiver (NYU; HR 0.53; 95% CI: 0.28, 0.99; 42-month effect); 3) Comprehensive Dementia Care (CDC; HR 0.60; 95% CI: 0.59, 0.61; 46-month effect); and 4) Adult Day Service Plus (ADS+; HR 0.44; 95% CI: 0.20, 0.94; 12-month effect). We evaluated each intervention’s cost-effectiveness relative to usual care from a societal perspective, and conducted 1-way, 2-way, and probabilistic sensitivity analyses.

RESULTS: All four interventions costed less and were more effective than usual care (i.e., dominated) from a societal perspective. MIND yielded the largest net cost savings ($15,048), followed by NYU ($5,428), CDC ($3,909) and ADS+ ($2,714). Results did not materially change in sensitivity analyses. The majority of cost saving was attributed to reductions in family and Medicaid nursing home spending.

CONCLUSIONS: Dementia-care interventions that reduce the rate of nursing home admissions are cost savings compared to usual care from a societal perspective.