14 July 2014
Modelling the economic impact of Cantab Mobile use in UK primary care
We evaluated the cost-effectiveness of introducing Cantab Mobile to the standard diagnostic pathways for patients presenting with subjective memory complaints (SMC) in the UK.
Accurate and timely diagnosis of dementia is important to allow individuals to access support, plan for the future and commence psychopharmacological treatments. However, there is great regional variability in the number of people diagnosed in a timely manner. In the UK, primary care acts as gatekeeper to the dementia diagnosis pathway, conducting basic initial assessment and deciding which patients should be referred for further investigation. We evaluated the cost-effectiveness of introducing Cantab Mobile to the standard diagnostic pathways for patients presenting with subjective memory complaints (SMC) in the UK.
We calculated the propensity of different groups to present to primary care with subjective memory complaints (SMC), including dementia, mild cognitive impairment, depression and the worried well. The cost of the diagnostic pathway was calculated from published literature (including NHS Reference Costs 2012-13, PSSRU, 2013), and was assumed to follow current UK NHS Clinical Guidelines (NICE, 2006). One-way sensitivity analysis was carried out on key model parameters. The disutility associated with untreated depression was also calculated in the model.
The model estimated that 47% of people presenting to primary care with SMC are likely to be ‘worried well’ and an additional 15% to have depression and not dementia. Therefore, less than half of patients presenting to primary care with SMC should be appropriately referred to dementia diagnostic services. The average diagnostic cost per patient presenting to primary care was £422.10. However, systematic use of a suitable cognitive test and depression screen in patients with SMC resulted in a reduction in diagnostic cost of 40% in comparison to no systematic assessment. Additional quality of life benefits were associated with earlier depression detection, including an associated reduction in disutility of 0.002 quality-adjusted life-years QALY’s (per patient).
This model illustrates the health economic benefits of accurate and appropriate primary care triage of possible dementia cases in the UK. Because primary care plays a key role in supporting and meeting the demands of an aging population, these findings have important implications for future service planning and healthcare providers.
View the partnering study, 'The sensitivity and specificity of computerised or paper and pencil cognitive assessments used in primary care impacts the cost-effectiveness of the dementia diagnostic pathway'
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