Skip to main content
SpringerLink
Log in

Dementia case management effectiveness on health care costs and resource utilization: a systematic review of randomized controlled trials

  • JNHA: Clinical Neurosciences
  • Published:
The journal of nutrition, health & aging

Abstract

The growing number of dementia patients leads to both policy, economic and health organization constraints. Many healthcare systems have developed case management programs in order to optimize dementia patients and caregivers care and services delivery. Nevertheless, to what extend case management programs can lead to an improvement of care and expenditures savings is not known. Thus, the objective of this paper was to analyse the efficacy of case management programs on health care cost, institutionalization and hospitalization. A systematic review of randomized controlled trials was therefore conducted of the databases MEDLINE and SCOPUS up to September 2009. Included were English language randomized controlled trials of case management for community dwelling dementia patients and their caregivers evaluating costs, institutionalization and hospitalization. An evaluation of the methodological quality was performed. Thirteen relevant studies concerning 12 trials were identified and included. None of the 7 low quality studies reported positive impact of case management on the outcomes of interest. Among the 6 good quality studies, 4 reported positive impact on institutionalization delay, institutionalization length or nursing home admission rate. In none of the good quality studies was evidence found for savings in health care expenditures or reduction in hospitalization recourse. The weak convincing evidences from randomized trials do not allow any conclusion about the efficacy of case management for dementia patient and caregivers on costs and resource utilization. Further research should focus on determining subgroups of caregivers who could benefit the most from case management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Comas-Herrera A, Wittenberg R, Pickard L, Knapp M. Cognitive impairment in older people: future demand for long-term care services and the associated costs. International journal of geriatric psychiatry. 2007 Oct;22:1037–1045.

    Article  PubMed  Google Scholar 

  2. Jonsson L, Wimo A. The cost of dementia in Europe: a review of the evidence, and methodological considerations. PharmacoEconomics. 2009;27:391–403.

    Article  PubMed  Google Scholar 

  3. Dartigues JF. Alzheimer's disease: a global challenge for the 21st century. Lancet neurology. 2009 Dec;8:1082–1083.

    Article  PubMed  Google Scholar 

  4. Rice DP, Fox PJ, Max W, Webber PA, Lindeman DA, Hauck WW, Segura E. The economic burden of Alzheimer's disease care. Health affairs (Project Hope). 1993 Summer;12:164–176.

    Article  CAS  Google Scholar 

  5. Leon J, Neumann PJ. The cost of Alzheimer's disease in managed care: a cross-sectional study. The American journal of managed care. 1999 Jul;5:867–877.

    CAS  PubMed  Google Scholar 

  6. Ernst RL, Hay JW, Fenn C, Tinklenberg J, Yesavage JA. Cognitive function and the costs of Alzheimer disease. An exploratory study. Archives of neurology. 1997 Jun;54:687–693.

    CAS  PubMed  Google Scholar 

  7. Lyketsos CG, Sheppard JM, Rabins PV. Dementia in elderly persons in a general hospital. The American journal of psychiatry. 2000 May;157:704–707.

    Article  CAS  PubMed  Google Scholar 

  8. Fields SD, MacKenzie CR, Charlson ME, Sax FL. Cognitive impairment. Can it predict the course of hospitalized patients? Journal of the American Geriatrics Society. 1986 Aug;34:579–585.

    CAS  PubMed  Google Scholar 

  9. Waldemar G, Phung KT, Burns A, Georges J, Hansen FR, Iliffe S, Marking C, Rikkert MO, Selmes J, et al. Access to diagnostic evaluation and treatment for dementia in Europe. International journal of geriatric psychiatry. 2007 Jan;22:47–54.

    Article  PubMed  Google Scholar 

  10. Knapp M, Prince M. Dementia UK: the full report,: London: Alzheimer's Society; 2007

    Google Scholar 

  11. Gallez C. Rapport sur la maladie d'Alzheimer et les maladies apparentées. OPEPS. 2005.

  12. Pucci E, Angeleri F, Borsetti G, Brizioli E, Cartechini E, Giuliani G, Solari A. General practitioners facing dementia: are they fully prepared? Neurol Sci. 2004 Feb;24:384–389.

    Article  CAS  PubMed  Google Scholar 

  13. Cody M, Beck C, Shue VM, Pope S. Reported practices of primary care physicians in the diagnosis and management of dementia. Aging & mental health. 2002 Feb;6:72–76.

    Article  CAS  Google Scholar 

  14. Turner S, Iliffe S, Downs M, Wilcock J, Bryans M, Levin E, Keady J, O'Carroll R. General practitioners’ knowledge, confidence and attitudes in the diagnosis and management of dementia. Age and ageing. 2004 Sep;33:461–467.

    Article  PubMed  Google Scholar 

  15. Yaffe K, Fox P, Newcomer R, Sands L, Lindquist K, Dane K, Covinsky KE. Patient and caregiver characteristics and nursing home placement in patients with dementia. Jama. 2002 Apr 24;287:2090–2097.

    Article  PubMed  Google Scholar 

  16. Vernooij-Dassen M, Felling A, Persoon J. Predictors of change and continuity in home care for dementia patients. International journal of geriatric psychiatry. 1997 Jun;12:671–677.

    Article  CAS  PubMed  Google Scholar 

  17. Brodaty H, McGilchrist C, Harris L, Peters KE. Time until institutionalization and death in patients with dementia. Role of caregiver training and risk factors. Archives of neurology. 1993 Jun;50:643–650.

    CAS  PubMed  Google Scholar 

  18. Gaugler JE, Kane RL, Kane RA, Clay T, Newcomer R. Caregiving and institutionalization of cognitively impaired older people: utilizing dynamic predictors of change. The Gerontologist. 2003 Apr;43:219–229.

    PubMed  Google Scholar 

  19. Case Management Society of America. Standarts of Practice for Case Management, Revised 2010.

  20. Newcomer R, Miller R, Clay T, Fox P. Effects of the Medicare Alzheimer's disease demonstration on Medicare expenditures. Health care financing review. 1999 Summer;20:45–65.

    CAS  PubMed  Google Scholar 

  21. Eloniemi-Sulkava U, Notkola IL, Hentinen M, Kivela SL, Sivenius J, Sulkava R. Effects of supporting community-living demented patients and their caregivers: a randomized trial. Journal of the American Geriatrics Society. 2001 Oct;49:1282–1287.

    Article  CAS  PubMed  Google Scholar 

  22. Vickrey BG, Mittman BS, Connor KI, Pearson ML, Della Penna RD, Ganiats TG, Demonte RW, Jr., Chodosh J, Cui X, et al. The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Annals of internal medicine. 2006 Nov 21;145:713–726.

    PubMed  Google Scholar 

  23. Wilson DB, Lipsey MW. The role of method in treatment effectiveness research: evidence from meta-analysis. Psychological methods. 2001 Dec;6:413–429.

    Article  CAS  PubMed  Google Scholar 

  24. Juni P, Altman DG, Egger M. Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ (Clinical research ed. 2001 Jul 7;323:42–46.

    Article  CAS  PubMed  Google Scholar 

  25. Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Journal of clinical epidemiology. 1998 Dec;51:1235–1241.

    Article  CAS  PubMed  Google Scholar 

  26. The Cochrane Collaboration, editor. Cochrane Reviewer's Handbook 4.2.2; Updated march 2004,.

  27. Weinberger M, Gold DT, Divine GW, Cowper PA, Hodgson LG, Schreiner PJ, George LK. Social service interventions for caregivers of patients with dementia: impact on health care utilization and expenditures. Journal of the American Geriatrics Society. 1993 Feb;41:153–156.

    CAS  PubMed  Google Scholar 

  28. Chu P, Edwards J, Levin R, Thompson J. The use of clinical case management for early stage Alzheimer's patients and their families. American Journal of Alzheimer's Disease and Other Dementias. 2000 September/October;15.

  29. Mohide EA, Pringle DM, Streiner DL, Gilbert JR, Muir G, Tew M. A randomized trial of family caregiver support in the home management of dementia. Journal of the American Geriatrics Society. 1990 Apr;38:446–454.

    CAS  PubMed  Google Scholar 

  30. Wright LK, Litaker M, Laraia MT, DeAndrade S. Continuum of care for Alzheimer's disease: a nurse education and counseling program. Issues in mental health nursing. 2001 Apr–May;22:231–252.

    Article  CAS  PubMed  Google Scholar 

  31. Callahan CM, Boustani MA, Unverzagt FW, Austrom MG, Damush TM, Perkins AJ, Fultz BA, Hui SL, Counsell SR, Hendrie HC. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. Jama. 2006 May 10;295:2148–2157.

    Article  CAS  PubMed  Google Scholar 

  32. Mittelman MS, Haley WE, Clay OJ, Roth DL. Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology. 2006 Nov 14;67:1592–1599.

    Article  PubMed  Google Scholar 

  33. Chien WT, Lee YM. A disease management program for families of persons in Hong Kong with dementia. Psychiatric services (Washington, DC. 2008 Apr;59:433–436.

    Article  PubMed  Google Scholar 

  34. Brodaty H, Mittelman M, Gibson L, Seeher K, Burns A. The effects of counseling spouse caregivers of people with Alzheimer disease taking donepezil and of country of residence on rates of admission to nursing homes and mortality. Am J Geriatr Psychiatry. 2009 Sep;17:734–743.

    Article  PubMed  Google Scholar 

  35. Clark PA, Bass DM, Looman WJ, McCarthy CA, Eckert S. Outcomes for patients with dementia from the Cleveland Alzheimer's Managed Care Demonstration. Aging & mental health. 2004 Jan;8:40–51.

    Article  CAS  Google Scholar 

  36. Duru OK, Ettner SL, Vassar SD, Chodosh J, Vickrey BG. Cost evaluation of a coordinated care management intervention for dementia. The American journal of managed care. 2009 Aug;15:521–528.

    PubMed  Google Scholar 

  37. Eloniemi-Sulkava U, Sivenius J, Sulkava R. Support program for demented patients and their carers: the role of dementia family care coordinator is crucial. In: Sons JWa, editor. Iqbal K, Swaab DF, Winblad B, Wisniewski HM Alzheimer's Disease and Related Disorders; 1999.

  38. Miller R, Newcomer R, Fox P. Effects of the Medicare Alzheimer's Disease Demonstration on nursing home entry. Health services research. 1999 Aug;34:691–714.

    CAS  PubMed  Google Scholar 

  39. Pinquart M, Sorensen S. Helping caregivers of persons with dementia: which interventions work and how large are their effects? International psychogeriatrics / IPA. 2006 Dec;18:577–595.

    Article  PubMed  Google Scholar 

  40. van der Roest HG, Meiland FJ, Comijs HC, Derksen E, Jansen AP, van Hout HP, Jonker C, Droes RM. What do community-dwelling people with dementia need? A survey of those who are known to care and welfare services. International psychogeriatrics / IPA. 2009 Oct;21:949–965.

    Article  PubMed  Google Scholar 

  41. Philp I, McKee KJ, Meldrum P, Ballinger BR, Gilhooly ML, Gordon DS, Mutch WJ, Whittick JE. Community care for demented and non-demented elderly people: a comparison study of financial burden, service use, and unmet needs in family supporters. BMJ (Clinical research ed. 1995 Jun 10;310:1503–1506.

    CAS  PubMed  Google Scholar 

  42. Dello Buono M, Busato R, Mazzetto M, Paccagnella B, Aleotti F, Zanetti O, Bianchetti A, Trabucchi M, De Leo D. Community care for patients with Alzheimer's disease and non-demented elderly people: use and satisfaction with services and unmet needs in family caregivers. International journal of geriatric psychiatry. 1999 Nov;14:915–924.

    Article  Google Scholar 

  43. Gaugler JE, Kane RL, Kane RA, Newcomer R. Early community-based service utilization and its effects on institutionalization in dementia caregiving. The Gerontologist. 2005 Apr;45:177–185.

    PubMed  Google Scholar 

  44. Graff MJ, Adang EM, Vernooij-Dassen MJ, Dekker J, Jonsson L, Thijssen M, Hoefnagels WH, Rikkert MG. Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study. BMJ (Clinical research ed. 2008 Jan 19;336:134–138.

    Article  PubMed  Google Scholar 

  45. Martikainen J, Valtonen H, Pirttila T. Potential cost-effectiveness of a family-based program in mild Alzheimer's disease patients. Eur J Health Econ. 2004 Jun;5:136–142.

    PubMed  Google Scholar 

  46. Nichols LO, Chang C, Lummus A, Burns R, Martindale-Adams J, Graney MJ, Coon DW, Czaja S. The cost-effectiveness of a behavior intervention with caregivers of patients with Alzheimer's disease. Journal of the American Geriatrics Society. 2008 Mar;56:413–420.

    Article  PubMed  Google Scholar 

  47. National Institute of Clinical Excellence. Guide to the methods of technology appraisal. 2004.

  48. Hjelmgren J, Berggren F, Andersson F. Health economic guidelines—similarities, differences and some implications. Value Health. 2001 May–Jun;4:225–250.

    Article  CAS  PubMed  Google Scholar 

  49. Jonsson B. Ten arguments for a societal perspective in the economic evaluation of medical innovations. Eur J Health Econ. 2009 Oct;10:357–359.

    Article  PubMed  Google Scholar 

  50. Gustavsson A, Jonsson L, McShane R, Boada M, Wimo A, Zbrozek AS. Willingness-to-pay for reductions in care need: estimating the value of informal care in Alzheimer's disease. International journal of geriatric psychiatry. 2009 Sep 14.

  51. Evers SM, Ament AJ, Blaauw G. Economic evaluation in stroke research: a systematic review. Stroke; a journal of cerebral circulation. 2000 May;31:1046–1053.

    CAS  PubMed  Google Scholar 

  52. Wimo A, Winblad B, Stoffler A, Wirth Y, Mobius HJ. Resource utilisation and cost analysis of memantine in patients with moderate to severe Alzheimer's disease. PharmacoEconomics. 2003;21:327–340.

    Article  CAS  PubMed  Google Scholar 

  53. Jonsson L, Andreasen N, Kilander L, Soininen H, Waldemar G, Nygaard H, Winblad B, Jonhagen ME, Hallikainen M, Wimo A. Patient- and proxy-reported utility in Alzheimer disease using the EuroQoL. Alzheimer disease and associated disorders. 2006 Jan–Mar;20:49–55.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. INSERM, U897, Bordeaux, F-33076, France

    Clément Pimouguet, J. F. Dartigues & C. Helmer

  2. Université Victor Segalen Bordeaux 2, Bordeaux, F-33076, France

    Clément Pimouguet, T. Lavaud, J. F. Dartigues & C. Helmer

  3. Université Paris IX Dauphine, Paris, F-75775, France

    T. Lavaud

  4. CHU de Bordeaux, Bordeaux, F-33076, France

    J. F. Dartigues

Authors
  1. Clément Pimouguet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Lavaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. F. Dartigues
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Helmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Clément Pimouguet.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pimouguet, C., Lavaud, T., Dartigues, J.F. et al. Dementia case management effectiveness on health care costs and resource utilization: a systematic review of randomized controlled trials. J Nutr Health Aging 14, 669–676 (2010). https://doi.org/10.1007/s12603-010-0314-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-010-0314-4

Key words

Search

Navigation