COST-UTILITY ANALYSIS OF COMMUNITY OCCUPATIONAL THERAPY IN DEMENTIA (COTID-UK) VERSUS USUAL CARE: RESULTS FROM VALID, A MULTI-SITE RANDOMIZED CONTROLLED TRIAL IN THE UK

Objectives: Aim of this work is to assess the costs, outcomes and the cost-utility of the Community Occupational Therapy in Dementia (COTiD-UK) intervention compared to Treatment as usual (TAU), using the within-trial data from the VALID RCT. Methods: A cost-utility analysis of the COTiD-UK intervention compared to TAU was performed using within-trial costs and outcomes data adopting the NHS perspective. Costs were calculated in 2017UK£ and include the cost of the COTiD-UK training for occupational therapists, the COTiD-UK intervention to person with dementia and supporters, the cost of NHS resource use (e.g. A&E and hospital admissions, GP consultations, etc.), medications, adaptations and equipment costs and changes in accommodation. The effectiveness of the intervention, captured using EQ5D-5L and DEMQOL questionnaires in both arms, were converted into QALYs, both for the person with dementia and the supporters. Extensive sensitivity analysis has been performed to control for uncertainty in the parameter values used. Results: The preliminary results of the analysis show that at 26 weeks there is some evidence that NHS costs are significantly higher in the COTiD-UK arm for person with dementia alone and for the person with dementia and supporters combined: this is mainly due to the cost of the COTiD-UK intervention. There is some evidence that in the intervention arm QALYs are higher in the person with dementia, but the findings are not statistically significant. Further work is currently exploring the broader societal costs and also modelling the long-term results beyond the trial. Conclusions: The preliminary results of this analysis seem to suggest that COTiD-UK is effective for the person with dementia, but the ICER is exceeding the recommended threshold of £20,000 per QALY. However these results do not take into account the societal costs (private costs, transport costs, productivity losses) for person with dementia and supporters, that may provide better results.