Health economic analysis of the integrated cognitive assessment tool to aid dementia diagnosis in the United Kingdom

OBJECTIVES: The aim of this study was to develop a comprehensive economic evaluation of the integrated cognitive assessment (ICA) tool compared with standard cognitive tests when used for dementia screening in primary care and for initial patient triage in memory clinics. METHODS: ICA was compared with standard of care comprising a mixture of cognitive assessment tools over a lifetime horizon and employing the UK health and social care perspective. The model combined a decision tree to capture the initial outcomes of the cognitive testing with a Markov structure that estimated long-term outcomes of people with dementia. Quality of life outcomes were quantified using quality-adjusted life years (QALYs), and the economic benefits were assessed using net monetary benefit (NMB). Both costs and QALYs were discounted at 3.5% per annum and cost-effectiveness was assessed using a threshold of £20,000 per QALY gained. RESULTS: ICA dominated standard cognitive assessment tools in both the primary care and memory clinic settings. Introduction of the ICA tool was estimated to result in a lifetime cost saving of approximately £123 and £226 per person in primary care and memory clinics, respectively. QALY gains associated with early diagnosis were modest (0.0016 in primary care and 0.0027 in memory clinic). The net monetary benefit (NMB) of ICA introduction was estimated at £154 in primary care and £281 in the memory clinic settings. CONCLUSION: Introduction of ICA as a tool to screen primary care patients for dementia and perform initial triage in memory clinics could be cost saving to the UK public health and social care payer.