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.

Details

Title
Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial
Author
Khan, Iftekhar 1   VIAFID ORCID Logo  ; Petrou, Stavros 2 ; Khan, Kamran 2 ; Mistry, Dipesh 2 ; Lall, Ranjit 2 ; Sheehan, Bart 3 ; Lamb, Sarah 4 ; Dosanjh, Sukhdeep; Alleyne, Sharisse; Hennings, Susie; Nichols, Vivien; Finnegan, S.; Atherton, Nicky; Brown, Debbie; Collins, Helen; Lawlor, Brian; Turner, Angela Clayton; Freeman, Jenny; McCrone, Paul; Jones, Roy; Hughes, Julian; Phillips, Patrick; Atherton, N.; Bridgewater, S.; Eyre, E.; Hall, L.; Hill, L.; Hall, P.; Johnson, H.; Kaur, G.; Langdon, L.; Lowe, J.; Mathews, S.; Millichap, J.; Nussbaum, J.; On-kar, I.; Ritchie, C.; Russell, V.; Scott, G.; Shore, S.; Slowther, A.; Spanjers, K.; Stonehewer, L.; Thorogood, M.; Todd, J.; Ullah, A.; Waters, H.; Woods, L.; Withers, E.; Zeh, P.; Bond, A.; Brown, D.; Byrne, C.; McShane, R.; Richmond, H.; Thomas, N.; Thompson, J.; Dransfield, C.; Le Frenais, F.; Hall, C.; Rye, O.; Carson, R.; Clarke, M.; Eaton, H.; Ellis, H.; Farrand, A.; Gardner, S.; Harducas, C.; Rigby, L.; Wilson, J.; Johnson, L.; Lord, L.; Qassam, T.; Sadier, S.; Shipman, A.; South, L.; Statham, J.; Tomkins, J.; Weaver, D.; Coope, B.; Craddock, D.; Johal, A.; Lee, J.; Lindsay, J.; Tucker, J.; Vanderputt, R.; Cross, V.; Glithens-Mather, G.; Martin, L.; O’Reilly, C.; Rogers, E.; Sheridan, R.; Birtwell, K.; Brooke, J.; Davis, A.; Hinze, C.; Hussain, S.; Kennedy, A.; Mistry, H.; Noble, R.; Norton, R.; Oughton, E.; Sherwin, V.; Tinker, P.; Glancey, D.; Karrin, H.; Marudkar, M.; Borley, G.; Crisp, T.; Koranteng, P.; Lovesy, A.; Vogel, S.; Browne, B.; Colbourn, L.; Feast, A.; Hanratty, E.; Legerd, R.; Niland-Smith, R.; Sullivan, Theresa; Sullivan, Tony; Streater, A.; St Roas, H.; Anderton, M.; Blake, R.; Brown, K.; Marriott, S.; Simpson, S.; Thornhill, A.; Dawe, F.; Kuruvilla, T.; Moore, L.; Phillips, M.; Riley, G.; Uthup, A.

1  University of Warwick, Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK (GRID:grid.7372.1) (ISNI:0000 0000 8809 1613); University of London, King’s College London, London, UK (GRID:grid.4464.2) (ISNI:0000 0001 2161 2573) 
2  University of Warwick, Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK (GRID:grid.7372.1) (ISNI:0000 0000 8809 1613) 
3  Oxford University Hospitals NHS Foundation Trust, Oxford, UK (GRID:grid.410556.3) (ISNI:0000 0001 0440 1440) 
4  University of Warwick, Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK (GRID:grid.7372.1) (ISNI:0000 0000 8809 1613); University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Rehabilitation Research In Oxford, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
Pages
215-227
Publication year
2019
Publication date
Jun 2019
Publisher
Springer Nature B.V.
ISSN
25094262
e-ISSN
25094254
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1007/s41669-018-0097-9
ProQuest document ID
2788832759
Copyright
© The Author(s) 2018. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.