Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial

DAPA Trial Group; Iftekhar Khan; Stavros Petrou; Kamran Khan; Dipesh Mistry; Ranjit Lall; Bart Sheehan; Sarah Lamb

doi:10.1007/s41669-018-0097-9

Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial

DAPA Trial Group
, Iftekhar Khan
, Stavros Petrou
, Kamran Khan
, Dipesh Mistry
, Ranjit Lall
, Bart Sheehan
, Sarah Lamb

University of Warwick
King's College London
Oxford University Hospitals NHS Foundation Trust
University of Oxford

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

68 Downloads (Pure)

Abstract

Background: Previous studies suggest that physical exercise could slow dementia progression. However, evidence for the cost effectiveness of structured exercise is conflicting and based on small trials.

Objectives: The objective of this study was to compare the cost effectiveness of a tailored, structured, moderate- to high-intensity exercise programme versus usual care in people with mild to moderate dementia.

Methods: An economic evaluation was conducted from the UK National Health Service and personal social services perspective, based on data from a large randomised controlled trial. The primary clinical outcome was the participant reported ADAS-Cog (Alzheimer’s Disease Assessment Scale–Cognitive Subscale) at 12 months. Costs (£; 2014–2015 prices) were collected prospectively over a 12-month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted with the view to estimating the incremental cost per QALY gained and the incremental net monetary benefit (INMB) associated with the exercise programme plus usual care versus usual care. Sensitivity analyses were undertaken to assess the impact of uncertainty surrounding aspects of the economic evaluation, and pre-specified subgroup analyses explored heterogeneity in the cost-effectiveness results.

Results: Participants (n = 494) were randomised to exercise plus usual care or usual care only. By 12 months the mean ADAS-Cog score had worsened slightly to 25.2 (standard deviation [SD] 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care: difference − 1.4, 95% confidence interval (CI) − 2.6 to − 0.2 (p = 0.03). The mean (standard error [SE]) costs over 12 months for experimental versus control was £5945 (US$7856) versus £4597 (US$6574), respectively; (difference: £1347 [$1926]; p = 0.0426). Mean (SE) QALY estimates were 0.787 (0.012) versus 0.826 (0.019), respectively (p = 0.090). The probability that the exercise programme is cost effective was < 1% across cost-effectiveness thresholds. INMBs ranged between –£2601 (US$3719) and £2158 (US$3086) at cost-effectiveness thresholds between £15,000 (US$21,450) and £30,000 (US$42,900) per QALY. The cost-effectiveness results remained robust to several sensitivity and subgroup analyses.

Conclusions: Building on the clinical results of the trial, which showed that the structured exercise programme evaluated does not slow cognitive impairment in people with mild to moderate dementia, this economic evaluation shows that the programme is not cost effective.

Original language	English
Pages (from-to)	215-227
Number of pages	13
Journal	PharmacoEconomics - Open
Volume	3
Issue number	2
Early online date	11 Sept 2018
DOIs	https://doi.org/10.1007/s41669-018-0097-9
Publication status	Published - Jun 2019

Bibliographical note

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

Pharmacology
Health Policy
Pharmacology (medical)

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DAPA Trial Group, Khan, I., Petrou, S., Khan, K., Mistry, D., Lall, R., Sheehan, B., & Lamb, S. (2019). Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial. PharmacoEconomics - Open, 3(2), 215-227. https://doi.org/10.1007/s41669-018-0097-9

Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial. / DAPA Trial Group; Khan, Iftekhar; Petrou, Stavros et al.
In: PharmacoEconomics - Open, Vol. 3, No. 2, 06.2019, p. 215-227.

Research output: Contribution to journal › Article › peer-review

DAPA Trial Group, Khan, I, Petrou, S, Khan, K, Mistry, D, Lall, R, Sheehan, B & Lamb, S 2019, 'Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial', PharmacoEconomics - Open, vol. 3, no. 2, pp. 215-227. https://doi.org/10.1007/s41669-018-0097-9

DAPA Trial Group, Khan I, Petrou S, Khan K, Mistry D, Lall R et al. Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial. PharmacoEconomics - Open. 2019 Jun;3(2):215-227. Epub 2018 Sept 11. doi: 10.1007/s41669-018-0097-9

@article{73baa98acc7a4394aa231237f89567b7,

title = "Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial",

abstract = "Background: Previous studies suggest that physical exercise could slow dementia progression. However, evidence for the cost effectiveness of structured exercise is conflicting and based on small trials. Objectives: The objective of this study was to compare the cost effectiveness of a tailored, structured, moderate- to high-intensity exercise programme versus usual care in people with mild to moderate dementia.Methods: An economic evaluation was conducted from the UK National Health Service and personal social services perspective, based on data from a large randomised controlled trial. The primary clinical outcome was the participant reported ADAS-Cog (Alzheimer{\textquoteright}s Disease Assessment Scale–Cognitive Subscale) at 12 months. Costs (£; 2014–2015 prices) were collected prospectively over a 12-month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted with the view to estimating the incremental cost per QALY gained and the incremental net monetary benefit (INMB) associated with the exercise programme plus usual care versus usual care. Sensitivity analyses were undertaken to assess the impact of uncertainty surrounding aspects of the economic evaluation, and pre-specified subgroup analyses explored heterogeneity in the cost-effectiveness results. Results: Participants (n = 494) were randomised to exercise plus usual care or usual care only. By 12 months the mean ADAS-Cog score had worsened slightly to 25.2 (standard deviation [SD] 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care: difference − 1.4, 95\% confidence interval (CI) − 2.6 to − 0.2 (p = 0.03). The mean (standard error [SE]) costs over 12 months for experimental versus control was £5945 (US\$7856) versus £4597 (US\$6574), respectively; (difference: £1347 [\$1926]; p = 0.0426). Mean (SE) QALY estimates were 0.787 (0.012) versus 0.826 (0.019), respectively (p = 0.090). The probability that the exercise programme is cost effective was < 1\% across cost-effectiveness thresholds. INMBs ranged between –£2601 (US\$3719) and £2158 (US\$3086) at cost-effectiveness thresholds between £15,000 (US\$21,450) and £30,000 (US\$42,900) per QALY. The cost-effectiveness results remained robust to several sensitivity and subgroup analyses. Conclusions: Building on the clinical results of the trial, which showed that the structured exercise programme evaluated does not slow cognitive impairment in people with mild to moderate dementia, this economic evaluation shows that the programme is not cost effective.",

author = "\{DAPA Trial Group\} and Iftekhar Khan and Stavros Petrou and Kamran Khan and Dipesh Mistry and Ranjit Lall and Bart Sheehan and Sarah Lamb and Sukhdeep Dosanjh and Sharisse Alleyne and Susie Hennings and Vivien Nichols and S. Finnegan and N. Atherton and Debbie Brown and Helen Collins and Brian Lawlor and Turner, \{Angela Clayton\} and Jenny Freeman and Paul McCrone and Roy Jones and Julian Hughes and Patrick Phillips and N. Atherton and S. Bridgewater and E. Eyre and S. Finnegan and L. Hall and L Hill and P. Hall and H. Johnson and G. Kaur and L Langdon and J. Lowe and S. Mathews and J. Millichap and J. Nussbaum and I. On-kar and C. Ritchie and V. Russell and G. Scott and S. Shore and A. Slowther and K. Spanjers and S. Stonehewer and M. Thorogood and J. Todd and A. Ullah and H. Waters and L. Woods and E. Withers and P. Zeh and A. Bond and D. Brown and C. Byrne and R. McShane and H. Richmond and N. Thomas and J. Thompson and C. Dransfield and \{Le Frenais\}, F. and C. Hall and O. Rye and R. Carson and M. Clarke and H. Eaton and H. Ellis and A. Farrand and S. Gardner and C. Harducas and L. Rigby and J. Wilson and L Hill and L. Johnson and L. Lord and L. Johnson and T. Qassam and S. Sadier and A. Shipman and L. South and J. Statham and J. Tomkins and D. Weaver and B. Coope and D. Craddock and A. Johal and J. Lee and J. Lindsay and J. Tucker and V. Vanderputt and V. Cross and G. Glithens-Mather and L. Martin and C. O'Reilly and E. Rogers and R. Sheridan and K. Birtwell and J. Brooke and A. Davis and C. Hinze and S. Hussain and A. Kennedy and H. Mistry and R. Noble and R. Norton and E. Oughton and V. Sherwin and P. Tinker and D. Glancey and H Karrin and M. Marudkar and G. Borley and T. Crisp and P Koranteng and A. Lovesy and S. Vogel and B. Browne and L. Colbourn and A. Feast and E. Hanratty and R. Legerd and R. Niland-Smith and Theresa Sullivan and Tony Sullivan and A. Streater and \{St Roas\}, H. and M. Anderton and R. Blake and K. Brown and S. Marriott and S. Simpson and A. Thornhill and L. Colbourn and F. Dawe and K. Kuruvilla and L. Moore and R. Niland-Smith and M. Phillips and G. Riley and A. Uthup",

note = "This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.",

year = "2019",

month = jun,

doi = "10.1007/s41669-018-0097-9",

language = "English",

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pages = "215--227",

journal = "PharmacoEconomics - Open",

issn = "2509-4262",

publisher = "Adis",

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TY - JOUR

T1 - Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial

T2 - The Dementia and Physical Activity (DAPA) Trial

AU - DAPA Trial Group

AU - Khan, Iftekhar

AU - Petrou, Stavros

AU - Khan, Kamran

AU - Mistry, Dipesh

AU - Lall, Ranjit

AU - Sheehan, Bart

AU - Lamb, Sarah

AU - Dosanjh, Sukhdeep

AU - Alleyne, Sharisse

AU - Hennings, Susie

AU - Nichols, Vivien

AU - Finnegan, S.

AU - Atherton, N.

AU - Brown, Debbie

AU - Collins, Helen

AU - Lawlor, Brian

AU - Turner, Angela Clayton

AU - Freeman, Jenny

AU - McCrone, Paul

AU - Jones, Roy

AU - Hughes, Julian

AU - Phillips, Patrick

AU - Atherton, N.

AU - Bridgewater, S.

AU - Eyre, E.

AU - Finnegan, S.

AU - Hall, L.

AU - Hill, L

AU - Hall, P.

AU - Johnson, H.

AU - Kaur, G.

AU - Langdon, L

AU - Lowe, J.

AU - Mathews, S.

AU - Millichap, J.

AU - Nussbaum, J.

AU - On-kar, I.

AU - Ritchie, C.

AU - Russell, V.

AU - Scott, G.

AU - Shore, S.

AU - Slowther, A.

AU - Spanjers, K.

AU - Stonehewer, S.

AU - Thorogood, M.

AU - Todd, J.

AU - Ullah, A.

AU - Waters, H.

AU - Woods, L.

AU - Withers, E.

AU - Zeh, P.

AU - Bond, A.

AU - Brown, D.

AU - Byrne, C.

AU - McShane, R.

AU - Richmond, H.

AU - Thomas, N.

AU - Thompson, J.

AU - Dransfield, C.

AU - Le Frenais, F.

AU - Hall, C.

AU - Rye, O.

AU - Carson, R.

AU - Clarke, M.

AU - Eaton, H.

AU - Ellis, H.

AU - Farrand, A.

AU - Gardner, S.

AU - Harducas, C.

AU - Rigby, L.

AU - Wilson, J.

AU - Hill, L

AU - Johnson, L.

AU - Lord, L.

AU - Johnson, L.

AU - Qassam, T.

AU - Sadier, S.

AU - Shipman, A.

AU - South, L.

AU - Statham, J.

AU - Tomkins, J.

AU - Weaver, D.

AU - Coope, B.

AU - Craddock, D.

AU - Johal, A.

AU - Lee, J.

AU - Lindsay, J.

AU - Tucker, J.

AU - Vanderputt, V.

AU - Cross, V.

AU - Glithens-Mather, G.

AU - Martin, L.

AU - O'Reilly, C.

AU - Rogers, E.

AU - Sheridan, R.

AU - Birtwell, K.

AU - Brooke, J.

AU - Davis, A.

AU - Hinze, C.

AU - Hussain, S.

AU - Kennedy, A.

AU - Mistry, H.

AU - Noble, R.

AU - Norton, R.

AU - Oughton, E.

AU - Sherwin, V.

AU - Tinker, P.

AU - Glancey, D.

AU - Karrin, H

AU - Marudkar, M.

AU - Borley, G.

AU - Crisp, T.

AU - Koranteng, P

AU - Lovesy, A.

AU - Vogel, S.

AU - Browne, B.

AU - Colbourn, L.

AU - Feast, A.

AU - Hanratty, E.

AU - Legerd, R.

AU - Niland-Smith, R.

AU - Sullivan, Theresa

AU - Sullivan, Tony

AU - Streater, A.

AU - St Roas, H.

AU - Anderton, M.

AU - Blake, R.

AU - Brown, K.

AU - Marriott, S.

AU - Simpson, S.

AU - Thornhill, A.

AU - Colbourn, L.

AU - Dawe, F.

AU - Kuruvilla, K.

AU - Moore, L.

AU - Niland-Smith, R.

AU - Phillips, M.

AU - Riley, G.

AU - Uthup, A.

N1 - This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

PY - 2019/6

Y1 - 2019/6

N2 - Background: Previous studies suggest that physical exercise could slow dementia progression. However, evidence for the cost effectiveness of structured exercise is conflicting and based on small trials. Objectives: The objective of this study was to compare the cost effectiveness of a tailored, structured, moderate- to high-intensity exercise programme versus usual care in people with mild to moderate dementia.Methods: An economic evaluation was conducted from the UK National Health Service and personal social services perspective, based on data from a large randomised controlled trial. The primary clinical outcome was the participant reported ADAS-Cog (Alzheimer’s Disease Assessment Scale–Cognitive Subscale) at 12 months. Costs (£; 2014–2015 prices) were collected prospectively over a 12-month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted with the view to estimating the incremental cost per QALY gained and the incremental net monetary benefit (INMB) associated with the exercise programme plus usual care versus usual care. Sensitivity analyses were undertaken to assess the impact of uncertainty surrounding aspects of the economic evaluation, and pre-specified subgroup analyses explored heterogeneity in the cost-effectiveness results. Results: Participants (n = 494) were randomised to exercise plus usual care or usual care only. By 12 months the mean ADAS-Cog score had worsened slightly to 25.2 (standard deviation [SD] 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care: difference − 1.4, 95% confidence interval (CI) − 2.6 to − 0.2 (p = 0.03). The mean (standard error [SE]) costs over 12 months for experimental versus control was £5945 (US$7856) versus £4597 (US$6574), respectively; (difference: £1347 [$1926]; p = 0.0426). Mean (SE) QALY estimates were 0.787 (0.012) versus 0.826 (0.019), respectively (p = 0.090). The probability that the exercise programme is cost effective was < 1% across cost-effectiveness thresholds. INMBs ranged between –£2601 (US$3719) and £2158 (US$3086) at cost-effectiveness thresholds between £15,000 (US$21,450) and £30,000 (US$42,900) per QALY. The cost-effectiveness results remained robust to several sensitivity and subgroup analyses. Conclusions: Building on the clinical results of the trial, which showed that the structured exercise programme evaluated does not slow cognitive impairment in people with mild to moderate dementia, this economic evaluation shows that the programme is not cost effective.

AB - Background: Previous studies suggest that physical exercise could slow dementia progression. However, evidence for the cost effectiveness of structured exercise is conflicting and based on small trials. Objectives: The objective of this study was to compare the cost effectiveness of a tailored, structured, moderate- to high-intensity exercise programme versus usual care in people with mild to moderate dementia.Methods: An economic evaluation was conducted from the UK National Health Service and personal social services perspective, based on data from a large randomised controlled trial. The primary clinical outcome was the participant reported ADAS-Cog (Alzheimer’s Disease Assessment Scale–Cognitive Subscale) at 12 months. Costs (£; 2014–2015 prices) were collected prospectively over a 12-month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted with the view to estimating the incremental cost per QALY gained and the incremental net monetary benefit (INMB) associated with the exercise programme plus usual care versus usual care. Sensitivity analyses were undertaken to assess the impact of uncertainty surrounding aspects of the economic evaluation, and pre-specified subgroup analyses explored heterogeneity in the cost-effectiveness results. Results: Participants (n = 494) were randomised to exercise plus usual care or usual care only. By 12 months the mean ADAS-Cog score had worsened slightly to 25.2 (standard deviation [SD] 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care: difference − 1.4, 95% confidence interval (CI) − 2.6 to − 0.2 (p = 0.03). The mean (standard error [SE]) costs over 12 months for experimental versus control was £5945 (US$7856) versus £4597 (US$6574), respectively; (difference: £1347 [$1926]; p = 0.0426). Mean (SE) QALY estimates were 0.787 (0.012) versus 0.826 (0.019), respectively (p = 0.090). The probability that the exercise programme is cost effective was < 1% across cost-effectiveness thresholds. INMBs ranged between –£2601 (US$3719) and £2158 (US$3086) at cost-effectiveness thresholds between £15,000 (US$21,450) and £30,000 (US$42,900) per QALY. The cost-effectiveness results remained robust to several sensitivity and subgroup analyses. Conclusions: Building on the clinical results of the trial, which showed that the structured exercise programme evaluated does not slow cognitive impairment in people with mild to moderate dementia, this economic evaluation shows that the programme is not cost effective.

UR - https://www.scopus.com/pages/publications/85080063825

U2 - 10.1007/s41669-018-0097-9

DO - 10.1007/s41669-018-0097-9

M3 - Article

AN - SCOPUS:85080063825

SN - 2509-4262

VL - 3

SP - 215

EP - 227

JO - PharmacoEconomics - Open

JF - PharmacoEconomics - Open

IS - 2

ER -

Does Structured Exercise Improve Cognitive Impairment in People with Mild to Moderate Dementia? A Cost-Effectiveness Analysis from a Confirmatory Randomised Controlled Trial: The Dementia and Physical Activity (DAPA) Trial

Abstract

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