Economic evaluation of non-pharmacological interventions in Alzheimer's disease

Sobral, Margarida; Oliveira, Susana

doi:10.1590/1980-5764-DN-2024-0219

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Original Article • Dement. neuropsychol. 19 • 2025 • https://doi.org/10.1590/1980-5764-DN-2024-0219 linkcopy

Economic evaluation of non-pharmacological interventions in Alzheimer's disease

Avaliação econômica de intervenções não farmacológicas na doença de Alzheimer

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

Alzheimer's disease (AD) has significant physical, psychological, and socioeconomic impacts, shortens life expectancy, and reduces quality of life. Non-pharmacological interventions (NPIs) in dementia provide health gains.

Objective: The aim of this study was to conduct a cost-utility study of NPIs in AD, assessing both the costs and health gains associated with cognitive stimulation interventions in AD patients.

Methods: A sample of 40 patients undergoing NPIs and another 40 individuals (control group) were included. Data collected included sociodemographic, clinical, cognitive, and functional information, as well as health status, quality of life, and outpatient costs.

Results: The NPI, considering the discounted cost value of €21,621.31 and the discounted quality-adjusted life year (QALY) gain of 0.81333, resulted in an estimated cost per QALY of €26,583.76. This cost per QALY is within the threshold generally considered acceptable by regulatory authorities in Portugal and in several European countries.

Conclusion: This study supports the recommendation that interventions adjusted to the needs of patients with AD should be implemented, which may include NPIs providing both health gains and economic value.

Keywords:
Alzheimer Disease; Healthcare Models; Quality of Life; Quality-Adjusted Life Years; Cost-Benefit Analysis

Sociodemographic and clinical characteristics		AD patients with intervention (n=40)	Control group (n=40)	p-value
Sex (%) (n)
	Women	80 (32)	72.5 (29)	0.451
	Men	20 (8)	27.5 (11)	0.451
Age (mean) (SD) (min/max)		78.60 (6.508) (65–93)	79.55 (6.457) (67–93)	0.514
Age group – years (%) (n)
	≤65	2.5 (1)	0 (0)	0.947
	>65–75	25 (10)	27.6 (22)
	>75–85	65.0 (26)	56.3 (45)
	>85–95	7.5 (3)	22.5 (8)
Marital status (%) (n)
	Married	65 (26)	47.5 (19)	0.295
	Widower	25 (10)	45 (18)
	Single	5 (2)	2 (5)
	Divorced	5 (2)	1 (2.5)
Years of education (mean) (SD) (min/max)		7.03 (4.526) (1–17)	5.73 (4.132) (0–15)	0.184
Education (%) (n)
	Illiterate	2.5 (1)	2.5 (1)	0.459
	Reading and writing	2.5 (1)	12.5 (5)
	4 years	55 (22)	65 (26)
	9 years	12.5 (5)	2.5 (1)
	11–12 years	10 (4)	2.5 (1)
	>12 years	17.5 (7)	15 (6)
Portuguese nationality (%) (n)		100 (40)	100 (40)	-
Profession (%)
	Retired	100	100	-
	Other	0	0	-
Social class (Graffar) (%) (n)
	I (high)	10 (4)	5 (2)	0.496
	II (medium-high)	10 (4)	10 (4)
	III (medium)	55 (22)	70 (28)
	IV (medium-low)	25 (10)	15 (6)
Number of years with dementia (mean) (SD)		3.97 (0.37)	3.07 (0.28)	0.07
Number of follow-ups (mean) (SD)		5.53 (0.63)	2.87 (0.29)	0.02
Living alone (%) (n)
	Yes	10 (4)	0 (0)	0.116
	No	90 (36)	100 (40)	0.116
Pharmacological intervention with antidementia (%) (n)
	Yes	70 (28)	77.5 (31)	0.612
	No	30 (12)	22.5 (9)	0.612

Neuropsychological and functional assessments		First evaluation		Second assessment		p-value*
Neuropsychological and functional assessments		Intervention group	Control group	Intervention group	Control group	p-value*
Barthel index (mean) (SD)		97.75 (6.97)	90.63 (13.06)	96.25 (8.06)	84.62 (17.40)	0.014
Lawton index (mean) (SD)		18.25 (4.71)	19.33 (5.5)	18.67 (4.74)	22.65 (5.63)	0.028
MMSE (mean) (min–max) (DP)		22.55 (13–29) (3.74)	19.80 (13–27) (3.71)	21.88 (13–29) (4.43)	18.25 (9–25) (3.96)	0.012
ACE-R (mean) (min–max)		64.93 (33–84)	52.62 (30–76)	62.83 (32–82)	52. 57 (32–76)	0.032
Attention/concentration (mean)		14.21	11.38	13.61	13.71	0.594
Memory (mean)		10.25	7.62	9.65	6.85	0.395
Fluency (mean)		4.75	3.11	5.09	2.48	0.244
Language (mean)		21.57	20.51	21.83	21.142	0.399
Visuoconstructive (mean)		13.39	10.95	12.87	10.71	0.051
Clinical dementia rating	CDR=1 (%) (n)	90 (36)	82.5 (33)	90 (36)	57.5 (23)	0.011
	CDR=2 (%) (n)	10 (4)	17.5 (7)	10 (4)	35 (14)
	CDR=3 (%) (n)	0 (0)	0 (0)	0	7.5 (3)

Mean value for health status	Intervention group	Control group
First evaluation	0.62833	0.54925
Second evaluation	0.61577	0.39548

Mean value for health status	Intervention group		Control group
Mean value for health status	Women	Men	Women	Men
First evaluation	0.61244	0.69188	0.55759	0.52727
Second evaluation	0.58984	0.71950	0.39072	0.40800
Difference between the first and second evaluations	-0.0226	+0.02762	-0.16687	-0.11927
QALY gains	0.14427	0.14689

	Year 0	Year 1	Year 2	Year 3	Year 4	Year 5	Year 6
Costs	2706.21€	3608.28€	3608.28€	3608.28€	3608.28€	3608.28€	3608.28€
Discounted costs	2706.21€	3469.50€	3336.06€	3207.75€	3084.37€	2965.74€	2851.68€
Total discounted costs	21,621.31€
QALY gains	0.05429	0.14479	0.14479	0.14479	0.14479	0.14479	0.14479
Discounted QALY gains	0.05429	0.13922	0.13387	0.12872	0.12377	0.11901	0.11443
Total discounted QALYs	0.81333
Costs per QALY	26,583.76€

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Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Note:

[TFN1] ^*
Wald's test, significant (one-tailed).