A memory clinic <i>v</i>. traditional community mental health team service: comparison of costs and quality

Rubinsztein, Judy S.; Rensburg, Marelna Janse van; Al‐Salihy, Zerak; Girling, Deborah M.; Lafortune, Louise; Radhakrishnan, Muralikrishnan; Brayne, Carol

doi:10.1192/pb.bp.113.044263

Cited by 20 publications

(33 citation statements)

References 33 publications

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“…Our estimates of overall mean cost of supporting a patient for 6 months including and following initial assessment are higher than the £742 (2010/2011 GBP) reported by Rubinsztein et al (). That was a small study and appears to have excluded primary care contacts.…”

Section: Discussionsupporting

confidence: 79%

“…The monthly cost of MAS in Croydon, including capital overheads, has been estimated at about £71 000 and £1200 per patient assuming 59 new patients a month (Curtis, 2014). Our estimates of overall mean cost of supporting a patient for 6 months including and following initial assessment are higher than the £742 (2010/2011 GBP) reported by Rubinsztein et al (2015). That was a small study and appears to have excluded primary care contacts.…”

Section: Comparison With Previous Researchcontrasting

confidence: 62%

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The cost of diagnosis and early support in patients with cognitive decline

Pennington

Gomes

Chrysanthaki

et al. 2016

Int J Geriat Psychiatry

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ObjectiveRecent research indicates considerable heterogeneity in the provision of memory assessment services (MAS). However, little is known on the extent of variation in the costs of the services MAS provide. We investigated the costs of supporting patients with suspected dementia, including assessment and support over the following six months. MethodsClinic costs were estimated on the basis of an organisational survey reporting staff roll, grade and activities. Costs of primary health and social care were estimated from questionnaire data reported by carers of patients at baseline, three and six months after referral. ResultsMean monthly staff costs at MAS were £73,000. Imaging at assessment cost an additional £3,500 per month. Monthly clinic cost per new patient assessed varied from £320 to £5,400 across clinics. Additional primary health and social care costs of £130-220 a month between baseline and six months were reported by carers. Costs of pharmacological and nonpharmacological treatments reported by carers were small. Informal care costs dwarfed health and social care costs when valued at a modest unit cost. The overall mean cost of supporting a patient for six months varied from £1,600 to £2,500 dependent on assumptions regarding the proportion of MAS intervention and review costs accrued at six months. ConclusionsThere is considerable variation in the intensity and associated costs of services provided by MAS. Further research should ascertain to what extent such variation is associated with differences in patient outcomes.3

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Section: Discussionsupporting

confidence: 79%

Section: Comparison With Previous Researchcontrasting

confidence: 62%

The cost of diagnosis and early support in patients with cognitive decline

Pennington

Gomes

Chrysanthaki

et al. 2016

Int J Geriat Psychiatry

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“…Unlike previous studies focussing on a single memory clinic (9,13,28), our results are representative of MAS across all regions in the country (14). This economic evaluation is based on rigorous collection of data on different measures of effectiveness (both disease-specific and generic HQRL measures reported by patients and carers), and costs to the NHS, social care, carers and patients (adopting a societal perspective).…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…A previous study that focused on a single memory clinic (13) found no difference in costs of dementia services provided by MAS compared to community health services. The relative cost-effectiveness of MAS in England is not known.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of Memory Assessment Services for the diagnosis and early support of patients with dementia in England

Gomes

Pennington

Wittenberg

et al. 2017

J Health Serv Res Policy

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BackgroundPolicy makers in England advocate referral of patients with suspected dementia to Memory Assessment Services (MAS) but it is unclear how any improvement in patients' health-related quality of life (HRQL) compares with the associated costs. AimsTo evaluate the cost-effectiveness of MAS for the diagnosis and follow-up care of patients with suspected dementia. MethodWe analysed observational data from 1318 patients referred to 69 MAS, and their lay carers (n=944), who completed resource use and HRQL questionnaires at baseline, three and six months. We reported mean differences in HRQL (disease-specific DEMQOL and generic EQ-5D-3L), quality-adjusted life years (QALYs) and costs between baseline and 6 months of referral to MAS. We also assessed cost-effectiveness of MAS across different patient subgroups and clinic characteristics. ResultsReferral to MAS was associated with gains in DEMQOL (mean gain 3.48, 95% confidence interval: 2.84 to 4.12), EQ-5D-3L (0.023, 0.008 to 0.038) and QALYs (0.006, 0.002 to 0.01).Mean total costs over six months, assuming a societal perspective, was £1,899 (£1277 to £2539). This yielded a negative incremental net monetary benefit, -£1724 (-£2388 to -£1085) assuming NICE's recommended willingness-to-pay threshold (£30,000 per QALY). These base case results were relatively robust to alternative assumptions about costs and HRQL.There was some evidence that patients aged 80 or older benefitted more from referral to MAS (p<0.01 from adjusted mean differences in net benefits) compared to younger patients. MAS with over 75 new patients a month or cost per patient less than £2500 were relatively more cost-effective (p < 0.01) than MAS with fewer new montly patients or higher cost per patient, respectively. ConclusionsDiagnosis, treatment and follow-up care provided by MAS to patients with suspected dementia appears to be effective, but not cost-effective over the first six months after diagnosis. Longer-term evidence is required before drawing conclusions about the costeffectiveness of MAS.

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“…Stated grounds for providing an early diagnosis include enabling more timely access to appropriate treatment, information and support (Department of Health, 2015;Prince, Bryce & Ferri, 2011). There are an increasing number of case-finding initiatives based on clinical cognitive assessments in hospitals or in routine health checks (Hawkins, 2015;Rubinsztein et al, 2015), but for the majority of people early diagnosis relies on timely helpseeking and appropriate assessment within primary care.…”

Section: Introductionmentioning

confidence: 99%

Relational experiences of people seeking help and assessment for subjective cognitive concern and memory loss

Birt

Poland

Charlesworth

et al. 2019

Aging & Mental Health

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Objective: To understand the experience of people who seek help for subjective cognitive concern and memory loss, including people not referred for further assessment. To understand the patients' perspective of the medical process of receiving a cognitive assessment. This work is situated within the context of policy priorities for dementia diagnosis. Methods: Participants with and without dementia were recruited through NHS trusts and community organisations in four regional areas in England. Data were collected using longitudinal qualitative interviews. Transcript data were thematically analysed. Results: Sample of 41 people (mean 75 years, 25 dementia diagnoses). Interpretative thematic analyses focused on the presence or absence of trust in relational experiences. There were three transition points where trust could be specifically developed or undermined: 1) deciding to seek help; 2) healthcare practitioners' response to help-seeking; 3) process and outcome of assessment. Triggers for help-seeking for subjective cognitive concern were being prompted by family and knowing a relative with dementia. When participants perceived healthcare practitioners' behaviour as dismissive, they had less trust in the outcome of the healthcare encounter. Misunderstandings and absence of trust in assessment processes led to participants stating they did not fully agree with the outcomes of the assessment. Conclusions: Healthcare practitioners have an important role in supporting people with subjective cognitive concern ensuring patients have trust in assessment outcomes. Where the validity of the assessment process is seen as ambiguous, people can be left dealing with uncertainty, rather than being clear about ways they can manage their condition, situation or status.

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A memory clinic v. traditional community mental health team service: comparison of costs and quality

Cited by 20 publications

References 33 publications

The cost of diagnosis and early support in patients with cognitive decline

The cost of diagnosis and early support in patients with cognitive decline

Cost-effectiveness of Memory Assessment Services for the diagnosis and early support of patients with dementia in England

Relational experiences of people seeking help and assessment for subjective cognitive concern and memory loss

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