Data from: Economic evaluation of a general hospital unit for older people with delirium and dementia (TEAM randomised controlled trial)

Background: One in three hospital acute medical admissions is of an older
person with cognitive impairment. Their outcomes are poor and the quality
of their care in hospital has been criticised. A specialist unit to care
for older people with delirium and dementia (the Medical and Mental Health
Unit, MMHU) was developed and then tested in a randomised controlled trial
where it delivered significantly higher quality of, and satisfaction with,
care, but no significant benefits in terms of health status outcomes at
three months. Objective: To examine the cost-effectiveness of the MMHU for
older people with delirium and dementia in general hospitals, compared
with standard care. Methods: Six hundred participants aged over 65
admitted for acute medical care, identified on admission as cognitively
impaired, were randomised to the MMHU or to standard care on acute
geriatric or general medical wards. Cost per quality adjusted life year
(QALY) gained, at 3-month follow-up, was assessed in trial-based economic
evaluation (599/600 participants, intervention: 309). Multiple imputation
and complete-case sample analyses were employed to deal with missing QALY
data (55%). Results: The total adjusted health and social care costs,
including direct costs of the intervention, at 3 months was £7714 and
£7862 for MMHU and standard care groups, respectively (difference -£149
(95% confidence interval [CI]: -298, 4)). The difference in QALYs gained
was 0.001 (95% CI: -0.006, 0.008). The probability that the intervention
was dominant was 58%, and the probability that it was cost-saving with
QALY loss was 39%. At £20,000/QALY threshold, the probability of
cost-effectiveness was 94%, falling to 59% when cost-saving QALY loss
cases were excluded. Conclusions: The MMHU was strongly cost-effective
using usual criteria, although considerably less so when the less
acceptable situation with QALY loss and cost savings were excluded.
Nevertheless, this model of care is worthy of further evaluation.