Cost-utility of a new psychosocial goal-setting and manualised support intervention for Independence in Dementia (NIDUS-Family) versus goal-setting and routine care: economic evaluation embedded within a randomised controlled trial
Bibliographic record
Abstract
Summary Background NIDUS-Family is a 6-8 session, psychosocial and behavioural intervention, delivered by non-clinical facilitators, tailored to goals set by dementia-unpaid/family carer dyads. It is effective in terms of attainment of personalised client goals. We aimed to determine if it is cost-effective. Methods This cost utility and cost-effectiveness analysis is within a two-armed, single masked, multi-site, superiority Randomised Controlled Trial (RCT). We recruited 302 dyads from community settings. Randomisation was blocked and site-stratified, using a 2:1 ratio (intervention: control (goal-setting and routine care)), with allocation by remote web-based system. We calculated the probability that NIDUS-Family is cost-effective for a client with dementia based on Quality Adjusted Life Year (QALY) from health and personal social services and societal perspectives, at £20,000-£30,000 decision thresholds for QALY gained, compared to usual care over 12 months. Analyses were intention-to-treat. Trial registration : ISRCTN11425138 . Findings From 30.4.2020-9.5.2022, 204 participants (109 (53.4%) female) were randomised to intervention and 98 (60 (61.2%) female) to control. 218 (72.2%) participants at 6 months and 178 (58.9%) at 12 months provided cost data. There was 89% and 87% probability that NIDUS-Family was cost-effective compared to usual care from personal social services and societal perspectives respectively. Intervention participants accrued on average £8934 (37%) less costs than control participants (95% CI -£59,460 to £41,592). Interpretation NIDUS-Family is the first personalised care and support intervention to demonstrate cost-effectiveness from the perspective of the quality of life of people with dementia, as well as clinical effectiveness and should be part of routine dementia care. Funding This work was supported by the Alzheimer’s Society (Centre of Excellence grant 330).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.024 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.009 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".