Search results for ‘Author:"et al"’ Sort:
Results 1 - 10 of 36
What are the current and projected future cost and health-related quality of life implications of scaling up cognitive stimulation therapy?
- Authors:
- KNAPP Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 37(1), 2022,
- Publisher:
- Wiley
Objectives: Cognitive stimulation therapy (CST) is one of the few non-pharmacological interventions for people living with dementia shown to be effective and cost-effective. What are the current and future cost and health-related quality of life implications of scaling-up CST to eligible new cases of dementia in England? Methods/design: Data from trials were combined with microsimulation and macrosimulation modelling to project future prevalence, needs and costs. Health and social costs, unpaid care costs and quality-adjusted life years (QALYs) were compared with and without scaling-up of CST and follow-on maintenance CST (MCST). Results: Scaling-up group CST requires year-on-year increases in expenditure (mainly on staff), but these would be partially offset by reductions in health and care costs. Unpaid care costs would increase. Scaling-up MCST would also require additional expenditure, but without generating savings elsewhere. There would be improvements in general cognitive functioning and health-related quality of life, summarised in terms of QALY gains. Cost per QALY for CST alone would increase from £12,596 in 2015 to £19,573 by 2040, which is below the threshold for cost-effectiveness used by the National Institute for Health and Care Excellence (NICE). Cost per QALY for CST and MCST combined would grow from £19,883 in 2015 to £30,906 by 2040, making it less likely to be recommended by NICE on cost-effectiveness grounds. Conclusions: Scaling-up CST England for people with incident dementia can improve lives in an affordable, cost-effective manner. Adding MCST also improves health-related quality of life, but the economic evidence is less compelling. (Edited publisher abstract)
Crystallising the case for deinstitutionalisation: COVID-19 and the experiences of persons with disabilities
- Authors:
- KNAPP Martin, et al
- Publisher:
- London School of Economics and Political Science, Care Policy and Evaluation Centre
- Publication year:
- 2021
- Pagination:
- 89
- Place of publication:
- London
- Edition:
- 8
This report summarises the evidence and experiences of persons living in congregate settings in general, and in terms of the impact of COVID-19, to understand the barriers to deinstitutionalisation, and to highlight the approaches that have sought to overcome those barriers. It considers all disabilities and long-term conditions that might lead to institutionalisation, for all age groups across the world. Congregate care remains a main form of provision for adults with disabilities in many countries, and the number of persons placed in congregate settings is rising in some regions of the world. Yet, overall, the majority of older persons experience better health, rights, and quality of life when support is provided in the community. Comparisons of community-based services with congregate living for persons with psychosocial or intellectual disabilities have consistently shown better outcomes, for example, in terms of health, quality of life, vocational rehabilitation, self-management and autonomy. A majority of persons strongly prefer living in community rather than institutional or hospital settings. A key barrier to deinstitutionalisation is prejudice against persons with disabilities and ageism, and therefore a lack of societal commitment to change the status quo. While with suitable community-based services, families can ensure better quality of life than is experienced in institutional settings, there may be no family members or friends available to be carers. There is also the challenge of shifting resources tied up in institutions and making them available for community support. Alternatives to congregate care settings may be seen as ‘too expensive’ by decisionmakers. Furthermore, the lack of legal and policy frameworks encompassing new community-based services in many countries creates a ‘perverse incentive’ in favour of placing persons with disabilities in institutions. The report argues that successful deinstitutionalisation requires long-term service planning, financial commitment and policy that looks beyond the electoral cycle. (Edited publisher abstract)
Crystallising the case for deinstitutionalisation: COVID-19 and the experiences of persons with disabilities
- Authors:
- KNAPP Martin, et al
- Publisher:
- London School of Economics and Political Science
- Publication year:
- 2021
- Pagination:
- 93
- Place of publication:
- London
This report summarises the evidence and experiences of persons living in congregate settings in general, and in terms of the impact of COVID-19, to understand the barriers to deinstitutionalisation, and to highlight the approaches that have sought to overcome those barriers. We consider all disabilities and long-term conditions that might lead to institutionalisation, for all age groups across the world. The COVID-19 pandemic is having severe impacts on millions of people living in institutional settings globally, including those with disabilities, children, and older people. The pandemic has exacerbated many of the existing failings of these settings: restrictions on individuals’ rights, damage to their physical and mental health, shortened life-spans, and constraints on social and economic activity. Residents in these settings were exposed to disproportionate risks of COVID infection, severe illness, and premature death. This was at least partially due to bans on visits by family and external health professionals. The research has led to a call for a national and global commitment to deinstitutionalisation. This is the process of replacing institutions with community-based services to support individuals with disabilities and older persons to live independently in the community – and to respect their choices. A key barrier to deinstitutionalisation is prejudice against those with disabilities and ageism, resulting in a lack of societal commitment to change the status quo. Stigma, poor understanding of disabilities, and discrimination underpin many of the other barriers highlighted by the report. These include lack of support within families, resources being directed to institutional rather than community-based support, and laws in some countries restricting people’s rights. The report sets out several recommendations to improve the lives of individuals with disabilities and age-related needs, including: improve societal awareness of disabilities and tackle discrimination; involve individuals with disabilities and older people in all discussions of policy change and practice development; establish community-based care by developing high-quality services, support people to make informed choices about where they live, and help families to support their loved ones. (Edited publisher abstract)
Short breaks for adults with learning disabilities and behaviour that challenges: economic evidence
- Authors:
- KNAPP Martin, et al
- Publisher:
- London School of Economics and Political Science, Care Policy and Evaluation Centre
- Publication year:
- 2019
- Pagination:
- 7
- Place of publication:
- London
This case summary presents economic evidence on short breaks for adults with learning disabilities, drawn from the NICE guideline on prevention, early intervention and minimising inpatient admissions. Although short breaks and respite care are intended to provide short-term relief for caregivers, it has become a long-term placement for some individuals with developmental disability. In evaluating short breaks, the work that fed into the NICE guideline did not find any robust evidence on their effectiveness or cost-effectiveness. Additional economic analyses from a public sector perspective demonstrated that short breaks can be considered cost-effective and potentially cost-saving, however, the analyses were based on assumptions rather than evidence. (Edited publisher abstract)
Peer-led self-management for people with severe mental health issues. A small-scale social care intervention: economic evidence
- Authors:
- KNAPP Martin, et al
- Publisher:
- London School of Economics and Political Science, Care Policy and Evaluation Centre
- Publication year:
- 2019
- Pagination:
- 4
- Place of publication:
- London
This case summary provides economic evidence on a peer-led, self-management intervention for people with severe mental health issues. The gave participants the opportunity to learn goal-setting and problem-solving techniques. It also offered an opportunity for participants to socialise and share experiences. The cost of the intervention was £894 per person (at 2011/12 prices). Costs associated with service utilisation over the first 6 months were on average £20 higher per week than at baseline. However, at 3-months post-intervention, costs were £62 per week lower than at baseline. Improved wellbeing and lifestyle associated with the intervention was responsible for 27% of these identified savings. (Edited publisher abstract)
Employment support for autistic adults: economic evidence
- Authors:
- KNAPP Martin, et al
- Publisher:
- London School of Economics and Political Science, Care Policy and Evaluation Centre
- Publication year:
- 2019
- Pagination:
- 7
- Place of publication:
- London
This case summary draws on available research to present economic evidence for employment support interventions providing individualised training and workplace support to enable autistic people to gain and maintain employment. The summary found that supported employment for autistic adults can be successful, though the evidence is based on a small number of small-scale studies. It also identifies a strong economic case for supported employment from both a health and social care perspective and a broader societal perspective, which includes productivity gains. (Edited publisher abstract)
Advocacy for parents with learning disabilities. A small-scale social care intervention: economic evidence
- Authors:
- KNAPP Martin, et al
- Publisher:
- London School of Economics and Political Science, Care Policy and Evaluation Centre
- Publication year:
- 2019
- Pagination:
- 4
- Place of publication:
- London
This case summary presents economic evidence on advocacy services for parents with learning disabilities that can be used during child safeguarding processes. For the evaluation, a research team worked with four advocacy services, which together provided information on seventeen case studies. This summary provides brief information on costs and savings. It reports savings especially from reduced safeguarding activities, care proceedings and care provision by advocacy. Increased access to interventions such as parenting programmes, debt advice, counselling, support for alcohol problems and victim support also generated potential net benefits in the long-term. (Edited publisher abstract)
British Red Cross 'Support at Home' hospital discharge scheme. A small-scale social care intervention: economic evidence
- Authors:
- KNAPP Martin, et al
- Publisher:
- London School of Economics and Political Science, Care Policy and Evaluation Centre
- Publication year:
- 2019
- Pagination:
- 4
- Place of publication:
- London
This case summary presents economic evidence on British Red Cross 'Support at Home' hospital discharge scheme. Through the scheme volunteers offer short-term (4–12 week) practical and emotional support for older people recently discharged from the hospital. A British Red Cross evaluation of the schemes effectiveness identified benefits such as enabling safe discharge, supporting carers and enabling patient advocacy. The intervention costs an average £169 per person, including volunteer time. The programme led to savings from older people needing less help with daily activities and improvements in wellbeing. These savings amounted to £884 per person on average (costs are at 2011 price levels). The summary notes that the quality of evidence on the evaluation was not high due to a lack of control group. (Edited publisher abstract)
A coping programme for family carers of people living with dementia: economic evidence
- Authors:
- KNAPP Martin, et al
- Publisher:
- London School of Economics and Political Science, Care Policy and Evaluation Centre
- Publication year:
- 2019
- Pagination:
- 7
- Place of publication:
- London
This case summary provides economic evidence on the cost effectiveness of the STrAtegies for RelaTives (START coping programme), which aims to help to reduce depression and anxiety in family carers of a person living with dementia. During the programme, carers receive an 8-week programme of individual psychological therapy sessions delivered by trained and supervised psychological graduates. The summary identifies evidence of the interventions effectiveness, carers views about the programme, and its cost-effectiveness. The evaluation found the programme to be cost-effective, offering value for money for the health and social care system. It recommends that longer-term follow-up evidence is needed to see if the START coping programme delays the admission of people living with dementia to care homes. It is one of a series of summaries carried out for the Essence project, which aims to make economic evidence available to decision-makers in England’s adult social care system. (Edited publisher abstract)
Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial)
- Authors:
- KNAPP Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1205-1216.
- Publisher:
- Wiley
Objective: Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild-to-moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. The authors examined whether continuing donepezil, or commencing memantine, is cost-effective for community-dwelling, moderate-to-severe Alzheimer's disease patients. Methods: Cost-effectiveness analysis was based on a 52-week, multicentre, double-blind, placebo-controlled, factorial clinical trial. A total of 295 community-dwelling patients with moderate/severe Alzheimer's disease, already treated with donepezil, were randomised to: (i) continue donepezil; (ii) discontinue donepezil; (iii) discontinue donepezil and start memantine; or (iv) continue donepezil and start memantine. Results: Continuing donepezil for 52 weeks was more cost-effective than discontinuation, considering cognition, activities of daily living and health-related quality of life. Starting memantine was more cost-effective than donepezil discontinuation. Donepezil–memantine combined is not more cost-effective than donepezil alone. Conclusions: Robust evidence is now available to inform clinical decisions and commissioning strategies so as to improve patients' lives whilst making efficient use of available resources. Clinical guidelines for treating moderate/severe Alzheimer's disease, such as those issued by NICE in England and Wales, should be revisited. (Edited publisher abstract)