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Developing the evidence base for adult social care practice: the NIHR School for Social Care Research
- Author:
- KNAPP Martin
- Journal article citation:
- Journal of Care Services Management, 4(2), January 2010, pp.167-179.
- Publisher:
- Taylor and Francis
In the introduction to ‘Shaping the Future of Care Together’, then Prime Minister Gordon Brown says that a care and support system reflecting the “needs of our times and meeting our rising aspirations” is achievable, but “only if we are prepared to rise to the challenge of radical reform”. A number of initiatives will be needed to meet the challenge of improving social care for the growing older population. This article describes how, before the unveiling of the green paper, the National Institute for Health Research (NIHR) announced that it has provided £15m over a five-year period to establish the NIHR School for Social Care Research, whose primary aim is to conduct or commission research that will help to improve adult social care practice in England. The author explains how this new school is seeking ideas for research topics, outline proposals for new studies and expert advice in developing research methods, and commissioning these ideas into practice.
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)
Dementia care costs and outcomes: literature review
- Authors:
- KNAPP Martin, ROMEO Renee, LEMMI Valentina
- Publisher:
- Alzheimer's Society
- Publication year:
- 2011
- Pagination:
- 31p.
- Place of publication:
- London
This study reviewed evidence on the cost-effectiveness of prevention, care and treatment strategies in relation to dementia. A systematic review was performed on available literature on economic evaluations of dementia care, searching key databases and websites in medicine, social care and economics. Literature reviews were privileged, and other study designs were included only to fill gaps in the evidence base. Fifty six literature reviews and 29 single studies offering economic evidence on dementia care were identified. There was more cost-effectiveness evidence on pharmacological therapies than other interventions. Acetylcholinesterase inhibitors for mild-to-moderate disease and memantine for moderate-to-severe disease were found to be cost-effective. Regarding non-pharmacological treatments, cognitive stimulation therapy, tailored activity programme and occupational therapy were found to be more cost-effective than usual care. There was some evidence to suggest that respite care in day settings and psychosocial interventions for carers could be cost-effective. Coordinated care management and personal budgets held by carers have also demonstrated cost-effectiveness in some studies.
Cognitive disability and direct care costs for elderly people
- Authors:
- KAVANAGH Shane, KNAPP Martin
- Journal article citation:
- British Journal of Psychiatry, 174(6), June 1999, pp.539-546.
- Publisher:
- Cambridge University Press
Population ageing and the high costs of care support for elderly people have concentrated attention on economic issues. Examines whether there is an association between costs and cognitive disability by comparing service utilisation and direct costs for elderly people with different degrees of cognitive disability, and between people living in households and in communal establishments. Discusses how population ageing is closely associated with higher utilisation of health and social care services, and how new treatment or service arrangements provoke debate about their cost implications. The study aims to provide 'benchmark' information to inform debates about the potential costs of various treatment and service charges.