A SYSTEMATIC REVIEW OF RESOURCE USE AND HEALTH OUTCOMES MEASUREMENT TOOLS IN CLINICAL TRIALS FOR DEMENTIA OR COGNITIVE IMPAIRMENT INTERVENTIONS
Dementia and cognitive impairment severely impact on patients’ life and bring heavy burden to patients, caregivers and societies. Some interventions are suggested for older patients with these conditions to help them live well, but economic evaluation is needed to assess the cost-effectiveness of these interventions. Among the methods available, trial-based economic evaluation is an ideal way, however, there is little consensus about the tools used to collect data of resource use and health outcomes alongside the trials. Therefore, the purpose of this systematic review was to synthesise the evidence base concerning the tools used to collect cost and outcome data in clinical trials of interventions for older patients with dementia or cognitive impairment.
Electronic databases were systematically searched using the key terms or their synonyms: aged, dementia, cognitive impairment, cost, quality of life, intervention and tools. The database searches were supplemented by searching through citations and references. Screening of both titles and abstracts were carried out by two independent reviewers. All disagreements were to be resolved by discussion or consultation with a third reviewer if necessary. Data analysis was reported in a narrative review.
Searches identified 2024 records; after removing duplicates, 1086 records were screened; 58 full-text articles assessed for eligibility and 44 studies were included in the review. For cost data collection, only two instruments were identified, Client Services Receipt Inventory (CSRI) and Resource Utilization in Dementia (RUD); most studies used the micro-costing method to calculate the costs. For health outcomes, Quality of Life in Alzheimer’s Disease (QOL-AD) was the most commonly used disease-specific instrument, followed by the Quality of Life in Late-stage Dementia (QUALID), Dementia Quality of Life (D-QOL), and Dementia Specific Health Related Quality of Life Measures (DEM-QOL). The generic instruments included several versions of the Short Form Health Survey (SF-8, SF-12, and SF-36), EuroQol 5-Dimensison (EQ-5D), Health Utilities Index Mark 3 (HUI3), and 15D instrument.
Several useful health outcomes tools have been identified by this review, which would contribute to the study design of trial-based economic evaluation. However, knowledge is limited about the cost data collection tools, so future research in this area is recommended.