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Cognitive stimulation therapy for people with dementia: cost effectiveness analysis
- Sunny T Varghese, Rose Mary Abraham, Lecturer Dept of Economics, Assumption College, Chaganaserry Kerala India (12 September 2006)
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Sunny T Varghese, Resident Dept. of Psychiatry All India Institute of Medical Sciences, New Delhi India, Rose Mary Abraham, Lecturer Dept of Economics, Assumption College, Chaganaserry Kerala India
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sunny_tv{at}rediffmail.com Sunny T Varghese, et al.
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Knapp et al (2006) have examined the cost effectiveness of Cognitive stimulation therapy in the treatment of dementia. The paper has lucidly explained the basics of cost effectiveness analysis (CEA) and has applied acceptability curves in the study, which made the paper interesting reading. Certain clarifications are required on the data presented in the study. a) The authors have used very wide inclusion criteria of MMSE (range 10-24) which could have influenced the outcome. The cost may appear less and benefits would appear large for treatment with people who have milder problems. b) The educational qualification of the patients has not been mentioned in the paper which would affect the outcome when MMSE is taken as the main outcome measure. c) The cost effectiveness that has been proved in the study may disappear if the costs of training the personnel are taken into account. d) Although the authors have mentioned that the cost of each session is £ 90 (£180 per week for two sessions for five patients)they have calculated the weekly rate per patient as £ 31.50. Further more the table 2 shows cost of intervention as £ 24.92, which needs more clarification.It is also not mentioned by the authors as to why the costs have been inflated to 2001 rates. e) In the outcome measure it is not clear why the authors have mentioned the change in ADAS- Cog score as -2.37 while in the initial study it is mentioned as +2.37 (Spector et al., 2003) References Knapp, M., Thorgrimsen, L., Patel, A., et al (2006) Cognitive stimulation therapy for people with dementia: cost effectiveness analysis.Br J Psychiatry, 188,574-580. Spector, A.,Thorgrimsen, L.,Woods, B., et al (2003) Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. Br J Psychiatry, 183, 248-254. |
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