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@ARTICLE{Michalowsky:270650,
      author       = {Michalowsky, Bernhard and Blotenberg, Iris and Platen,
                      Moritz and Teipel, Stefan and Kilimann, Ingo and
                      Portacolone, Elena and Bohlken, Jens and Rädke, Anika and
                      Buchholz, Maresa and Scharf, Annelie and Muehlichen, Franka
                      and Xie, Feng and Thyrian, Jochen René and Hoffmann,
                      Wolfgang},
      title        = {{C}linical {O}utcomes and {C}ost-{E}ffectiveness of
                      {C}ollaborative {D}ementia {C}are: {A} {S}econdary
                      {A}nalysis of a {C}luster {R}andomized {C}linical {T}rial.},
      journal      = {JAMA network open},
      volume       = {7},
      number       = {7},
      issn         = {2574-3805},
      address      = {Chicago, Ill.},
      publisher    = {American Medical Association},
      reportid     = {DZNE-2024-00822},
      pages        = {e2419282},
      year         = {2024},
      abstract     = {Long-term evidence for the effectiveness and
                      cost-effectiveness of collaborative dementia care management
                      (CDCM) is lacking.To evaluate whether 6 months of CDCM is
                      associated with improved patient clinical outcomes and
                      caregiver burden and is cost-effective compared with usual
                      care over 36 months.This was a prespecified secondary
                      analysis of a general practitioner (GP)-based, cluster
                      randomized, 2-arm clinical trial conducted in Germany from
                      January 1, 2012, to December 31, 2014, with follow-up until
                      March 31, 2018. Participants were aged 70 years or older,
                      lived at home, and screened positive for dementia. Data were
                      analyzed from March 2011 to March 2018.The intervention
                      group received CDCM, comprising a comprehensive needs
                      assessment and individualized interventions by nurses
                      specifically qualified for dementia care collaborating with
                      GPs and health care stakeholders over 6 months. The control
                      group received usual care.Main outcomes were
                      neuropsychiatric symptoms (Neuropsychiatric Inventory
                      [NPI]), caregiver burden (Berlin Inventory of Caregivers'
                      Burden in Dementia [BIZA-D]), health-related quality of life
                      (HRQOL, measured by the Quality of Life in Alzheimer Disease
                      scale and 12-Item Short-Form Health Survey [SF-12]),
                      antidementia drug treatment, potentially inappropriate
                      medication, and cost-effectiveness (incremental cost per
                      quality-adjusted life year [QALY]) over 36 months. Outcomes
                      between groups were compared using multivariate regression
                      models adjusted for baseline scores.A total of 308 patients,
                      of whom 221 $(71.8\%)$ received CDCM (mean [SD] age, 80.1
                      [5.3] years; 142 $[64.3\%]$ women) and 87 $(28.2\%)$
                      received usual care (mean [SD] age, 79.2 [4.5] years; 50
                      $[57.5\%]$ women), were included in the clinical
                      effectiveness analyses, and 428 (303 $[70.8\%]$ CDCM, 125
                      $[29.2\%]$ usual care) were included in the
                      cost-effectiveness analysis (which included 120 patients who
                      had died). Participants receiving CDCM showed significantly
                      fewer behavioral and psychological symptoms (adjusted mean
                      difference [AMD] in NPI score, -10.26 $[95\%$ CI, -16.95 to
                      -3.58]; P = .003; Cohen d, -0.78 $[95\%$ CI, -1.09 to
                      -0.46]), better mental health (AMD in SF-12 Mental Component
                      Summary score, 2.26 $[95\%$ CI, 0.31-4.21]; P = .02; Cohen
                      d, 0.26 $[95\%$ CI, -0.11 to 0.51]), and lower caregiver
                      burden (AMD in BIZA-D score, -0.59 $[95\%$ CI, -0.81 to
                      -0.37]; P < .001; Cohen d, -0.71 $[95\%$ CI, -1.03 to
                      -0.40]). There was no difference between the CDCM group and
                      usual care group in use of antidementia drugs (adjusted odds
                      ratio, 1.91 $[95\%$ CI, 0.96-3.77]; P = .07; Cramér V,
                      0.12) after 36 months. There was no association with overall
                      HRQOL, physical health, or use of potentially inappropriate
                      medication. The CDCM group gained QALYs (0.137 $[95\%$ CI,
                      0.000 to 0.274]; P = .049; Cohen d, 0.20 $[95\%$ CI, -0.09
                      to 0.40]) but had no significant increase in costs (437€
                      [-5438€ to 6313€] [US $476 (95\% CI, -$5927 to $6881)];
                      P = .87; Cohen d, 0.07 [95\% CI, -0.14 to 0.28]), resulting
                      in a cost-effectiveness ratio of 3186€ (US $3472) per
                      QALY. Cost-effectiveness was significantly better for
                      patients living alone (CDCM dominated, with lower costs and
                      more QALYs gained) than for those living with a caregiver
                      (47 538€ [US $51 816] per QALY).In this secondary analysis
                      of a cluster randomized clinical trial, CDCM was associated
                      with improved patient, caregiver, and health system-relevant
                      outcomes over 36 months beyond the intervention period.
                      Therefore, it should become a health policy priority to
                      initiate translation of CDCM into routine
                      care.ClinicalTrials.gov Identifier: NCT01401582.},
      keywords     = {Humans / Cost-Benefit Analysis / Female / Male / Dementia:
                      therapy / Dementia: economics / Aged / Aged, 80 and over /
                      Quality of Life / Caregivers: psychology / Germany /
                      Caregiver Burden: psychology / Quality-Adjusted Life Years},
      cin          = {AG Hoffmann / AG Michalowsky ; AG Michalowsky / AG Thyrian
                      / AG Teipel},
      ddc          = {610},
      cid          = {I:(DE-2719)1510600 / I:(DE-2719)5000067 /
                      I:(DE-2719)1510800 / I:(DE-2719)1510100},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:38967926},
      pmc          = {pmc:PMC11227088},
      doi          = {10.1001/jamanetworkopen.2024.19282},
      url          = {https://pub.dzne.de/record/270650},
}