Cost effectiveness of using cognitive screening tests for detecting dementia and mild cognitive impairment in primary care

Abstract

Introduction We estimated the cost effectiveness of different cognitive screening tests for use by General Practitioners (GPs) to detect cognitive impairment in England. Methods A patient‐level cost‐effectiveness model was developed using a simulated cohort that represents the elderly population in England (65 years and older). Each patient was followed over a lifetime period. Data from published sources were used to populate the model. The costs include government funded health and social care, private social care and informal care. Patient health benefit was measured and valued in Quality Adjusted Life Years (QALYs). Results Base‐case analyses found that adopting any of the three cognitive tests (Mini‐Mental State Examination, 6‐Item Cognitive Impairment Test or GPCOG (General Practitioner Assessment of Cognition)) delivered more QALYs for patients over their lifetime and made savings across sectors including healthcare, social care and informal care compared with GP unassisted judgement. The benefits were due to early access to medications. Among the three cognitive tests, adopting the GPCOG was considered the most cost‐effective option with the highest Incremental Net Benefit (INB) at the threshold of £30 000 per QALY from both the National Health Service and Personal Social Service (NHS PSS) perspective (£195 034 per 1000 patients) and the broader perspective that includes private social care and informal care (£196 251 per 1000 patients). Uncertainty was assessed in both deterministic and probabilistic sensitivity analyses. Conclusions Our analyses indicate that the use of any of the three cognitive tests could be considered a cost‐effective strategy compared with GP unassisted judgement. The most cost‐effective option in the base‐case was the GPCOG. Copyright © 2016 John Wiley & Sons, Ltd.

The social and economic burden of frontotemporal degeneration

“…Table 4 reports HUI3 15 , 16 scores and QALYs 17 by severity of disease, FTD subtype, and caregiver-patient dyadic relationships. HUI3 scores and QALYs were lower for patients in the severe and terminal stages, with scores indicating that patients' quality of life is worse than dead ( p < 0.001).…”

“…The HUI3 provides utility scores ranging from 1 (reflecting perfect health) to 0 (dead) with negative scores possible (minimum score −0.371) and reflecting health states deemed “worse than being dead.” 15 We estimated quality-adjusted life-years (QALYs), representing quality-adjusted life expectancy, by multiplying health utility by survival time. 17 As is the case with health utility, negative QALYs are possible, reflecting survival in health states being worse than death. Negative HUI3 and QALY scores reflect the respondents' belief that there is no perceived positive quality of life for the patient in this state.…”

Challenges in the diagnosis of dementia: insights from the United Kingdom-Brazil Dementia Workshop

“…A recent survey found the three tests most commonly used by British GPs are the Mini-Mental State Examination (MMSE), GP Assessment of Cognition (GPCOG), and the 6-Item Cognitive Impairment Test (6CIT). 12 In Brazil, the MMSE 13 is the most commonly used tool, as suggested by the Brazilian Ministry of Health Protocol for Alzheimer's Evaluation. 14 The use of MMSE, however, is not fully standardized, not only because of the lack of training, but also due to the frequent use of cultural adaptations.…”

Quality improvement in neurology

“…MCI is clinically important, but often not recognized, and if recognized may not be addressed. 11,12 Since cognition is the most sensitive indicator of brain function, and is costeffectively assessed, this creates an enormous opportunity to improve neurologic care. Cognitive impairment is a dominant comorbidity influencing not only what care is recommended for that problem, but also how care for all other illnesses should be provided.…”

“…11 Although there is conflicting evidence on the benefits of screening for dementia in older adults, there is growing support for the benefits of assessment of cognitive health in patients over the age of 65. 12,22 An Advisory Council for Alzheimer's Research, Care, and Services convened to advise the Department of Health and Human Services after the passage of the National Alzheimer's Project Act of 2011 has recommended identifying early stages of AD including MCI as a national priority. 23 Documenting impaired cognitive health in a shared problem list in the patient's medical record can be invaluable in alerting other clinicians providing a patient's care and avoiding mismanagement.…”