The cost-effectiveness of grip on challenging behaviour: an economic evaluation of a care programme for managing challenging behaviour.
OBJECTIVE
The objective of the study was to evaluate the cost-effectiveness of implementing the Grip on Challenging Behaviour care programme (GRIP) on dementia special care units in comparison with usual care.


METHODS
A stepped wedge design was used. Challenging behaviour and quality of life were measured using the Cohen Mansfield Agitation Inventory (CMAI) and the QUALIDEM. Quality-adjusted life years (QALYs) were calculated using the EuroQol-5D. Psychoactive medication use (range 0-5 per measurement) and sick leave were registered. Costs included medication, time spent on challenging behaviour and education. Costs and effects were analysed using linear multilevel regression. Incremental cost-effectiveness ratios were calculated. Statistical uncertainty was estimated using bootstrapping.


RESULTS
Seventeen dementia special care units participated. GRIP led to improvement on the QUALIDEM subscale social relations (1.6; 95% CI 0.18 to 3.4) and on the use of psychoactive medication (-0.73; 95% CI -1.1 to -0.46) and to a decrease in QALYs (-0.02; 95% CI -0.06 to -0.003). No significant effects on CMAI, sick leave and other QUALIDEM subscales were found. The intervention was not cost-effective in comparison with usual care with regard to CMAI score, QALYs and sick leave. The willingness to pay should be 320€/point improvement on the QUALIDEM subscale social relations and 370€/psychoactive medication less to reach a 0.95 probability of cost-effectiveness.


CONCLUSION
It depends on how much society is willing to pay whether GRIP can be considered cost-effective. Because the appropriateness of the current methods for analysing cost-effectiveness in this specific population is uncertain, the positive effects on behaviour, medication and job satisfactions should also be taken in account in the decision making.
['Zwijsen|S A|SA|', 'Bosmans|J E|JE|', 'Gerritsen|D L|DL|', 'Pot|A M|AM|', 'Hertogh|C M P M|CM|', 'Smalbrugge|M|M|']
D000041:Absenteeism D000328:Adult D000368:Aged D032763:Behavior Control D003362:Cost-Benefit Analysis D003704:Dementia D005260:Female D017048:Health Care Costs D006801:Humans D007588:Job Satisfaction D008297:Male D001523:Mental Disorders D008875:Middle Aged D009426:Netherlands D009735:Nursing Homes D011595:Psychomotor Agitation D011619:Psychotropic Drugs D011788:Quality of Life D019057:Quality-Adjusted Life Years
cost-effectiveness behaviour dementia stepped wedge design nursing home