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Does exercise improve cognitive impairment in people with mild to moderate dementia? A cost-effectiveness analysis from a confirmatory randomised controlled trial (DAPA Trial)

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DAPA trial group (Including: Khan, Iftekhar, Petrou, Stavros, Khan, Kamran, Mistry, Dipesh, Lall, Ranjit, Sheehan, B. and Lamb, S. E. (Sallie E.)). (2019) Does exercise improve cognitive impairment in people with mild to moderate dementia? A cost-effectiveness analysis from a confirmatory randomised controlled trial (DAPA Trial). PharmacoEconomics -Open, 3 . pp. 215-227. doi:10.1007/s41669-018-0097-9

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Official URL: https://doi.org/10.1007/s41669-018-0097-9

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Abstract

Background
Previous studies suggest that physical exercise could slow dementia progression. However, evidence for the cost effectiveness of structured exercise is conflicting and based on small trials.

Objectives
The objective of this study was to compare the cost effectiveness of a tailored, structured, moderate- to high-intensity exercise programme versus usual care in people with mild to moderate dementia.

Methods
An economic evaluation was conducted from the UK National Health Service and personal social services perspective, based on data from a large randomised controlled trial. The primary clinical outcome was the participant reported ADAS-Cog (Alzheimer’s Disease Assessment Scale–Cognitive Subscale) at 12 months. Costs (£; 2014–2015 prices) were collected prospectively over a 12-month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted with the view to estimating the incremental cost per QALY gained and the incremental net monetary benefit (INMB) associated with the exercise programme plus usual care versus usual care. Sensitivity analyses were undertaken to assess the impact of uncertainty surrounding aspects of the economic evaluation, and pre-specified subgroup analyses explored heterogeneity in the cost-effectiveness results.

Results
Participants (n = 494) were randomised to exercise plus usual care or usual care only. By 12 months the mean ADAS-Cog score had worsened slightly to 25.2 (standard deviation [SD] 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care: difference − 1.4, 95% confidence interval (CI) − 2.6 to − 0.2 (p = 0.03). The mean (standard error [SE]) costs over 12 months for experimental versus control was £5945 (US$7856) versus £4597 (US$6574), respectively; (difference: £1347 [$1926]; p = 0.0426). Mean (SE) QALY estimates were 0.787 (0.012) versus 0.826 (0.019), respectively (p = 0.090). The probability that the exercise programme is cost effective was < 1% across cost-effectiveness thresholds. INMBs ranged between –£2601 (US$3719) and £2158 (US$3086) at cost-effectiveness thresholds between £15,000 (US$21,450) and £30,000 (US$42,900) per QALY. The cost-effectiveness results remained robust to several sensitivity and subgroup analyses.

Conclusions
Building on the clinical results of the trial, which showed that the structured exercise programme evaluated does not slow cognitive impairment in people with mild to moderate dementia, this economic evaluation shows that the programme is not cost effective.

Item Type: Journal Article
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit
Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Dementia -- Treatment, Exercise for older people -- Psychological aspects, Dementia -- Patients -- Rehabilitation, Dementia -- Exercise therapy, Dementia -- Alternative treatment
Journal or Publication Title: PharmacoEconomics -Open
Publisher: Springer
ISSN: 2509-4262
Official Date: June 2019
Dates:
DateEvent
June 2019Published
11 September 2018Available
3 September 2018Accepted
Volume: 3
Page Range: pp. 215-227
DOI: 10.1007/s41669-018-0097-9
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
NIHR HTA 09/80/04[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
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