To examine the cost-effectiveness of a digitally supported care management system (CMS) for caregivers of people with dementia (PwD) compared with usual care.
The analysis was based on 192 caregivers (n = 96 CMS, n = 96 usual care) of PwD in a cluster-randomized controlled trial testing a digitally supported CMS, aiming to identify and address caregivers’ unmet needs and develop and implement an individualized support and care plan over 6 months. Incremental costs from the public-payer and societal perspectives, quality-adjusted life years (QALY), and the incremental cost-effectiveness ratio 6 months after baseline were calculated using multivariate regression models. We assessed the probability of cost-effectiveness using a range of willingness-to-pay thresholds.
Caregivers in the intervention group gained QALYs (+0.004 [95% CI −0.003 to 0.012], P value = .225) and had lower costs from the public payer (−378€ [1926-1168], P value = .630), but higher costs from the societal perspective (+1324 [−3634 to 6284], P value = .599). The intervention dominated usual care from the payer perspective, whereas the incremental cost-effectiveness ratio was €331 000/QALY from a societal perspective. The probability of cost-effectiveness was 72% and 79% from the public payer and 33% and 35% from a societal perspective at the willingness-to-pay thresholds threshold of €40 000 and €80 000/QALY gained.
CMS was likely cost-effective from the payer but not from a societal perspective, underlining the importance of informal care. The gain in QALY was marginal and could be due to the short observation period. Focusing on both the caregiver and the PwD, rather than assessing the PwD needs through the caregiver, could improve the cost-effectiveness results.
This research evaluates a digitally supported care management system designed to assist caregivers of individuals with dementia, comparing its cost-effectiveness to standard care. Nearly 1.8 million people in Germany live with dementia, and most receive support from informal caregivers, who often face significant stress and health risks. Understanding the financial efficiency of caregiver support programs is crucial for healthcare decision making, especially as caregiver burdens can lead to negative health outcomes and increased care costs.
The study involved 192 caregivers, split between those using the care management system and those receiving regular care over 6 months. Results indicated that caregivers using the system had slightly better quality-adjusted life years (QALYs), but the costs varied significantly based on perspective. From the public payers' view, the intervention appeared cost-effective, suggesting lower costs and better outcomes. However, from a broader societal perspective, the costs were higher due to informal care expenses, leading to questions about overall cost-effectiveness.
The findings emphasize the importance of considering both caregivers and the individuals they care for in these programs. A greater focus on the caregivers’ needs, alongside those of the patients, may enhance the effectiveness and efficiency of interventions. The study suggests that while the digitally supported care management system has potential benefits for caregivers, longer-term studies are needed to fully assess its impact on their health and well-being.
Overall, this research is vital for patients, healthcare decision makers, and researchers, highlighting the need for integrated support systems that address the complexities of caregiving in dementia care. It underscores the challenge of balancing costs and benefits, inviting further investigation into the long-term advantages of such interventions.