Cost-Consequence Analysis of a Dementia Specialist Training Program for Home Care Workers: Results From a Stepped-Wedge Cluster-Randomised Controlled Trial.

objectivesThis paper reports the health economic component of the broader Promoting Independence Through Quality Dementia Care at Home (PITCH). The broader PITCH trial primarily evaluated the effect of dementia training on home care workers' competence in providing dementia care; this analysis evaluated intervention costs and selected secondary client and caregiver outcomes.

methodsThe PITCH intervention was tested via a multi-site national pragmatic stepped-wedge cluster randomised clinical trial, conducted across three Australian states. A micro-costing approach was used to estimate intervention and resource use costs. Secondary outcomes for clients and caregivers, including quality of life (QoL), caregiver burden and dyadic interaction, were assessed. Means (SDs) described costs and outcomes, with linear and multilevel mixed-effects regression used to estimate crude and adjusted mean differences, respectively.

resultsThere were no significant improvements in most client and caregiver health, QoL, caregiver burden or dyadic interaction outcomes during the intervention phase, with decreases in proxy-reported Dementia QoL Utility (DEMQOL-U) and client self-reported visual analogue scale (EQ VAS). Improvements in caregiver burden and dyadic interaction were observed but were not statistically significant. Total costs increased from AU$68,925 in the control to AU$133,660 in the intervention phase, with an adjusted mean difference of AU$67,146 (95% CI: AU$16,957 to AU$117,334).

conclusionsThis health economic analysis should be interpreted separately from and alongside, the main PITCH trial findings on the primary outcome of home care workers' competence. Within this secondary analysis, PITCH was associated with higher total costs during the intervention phase and no clear evidence of improvement in the selected secondary client and caregiver outcomes.