{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:39:12Z","timestamp":1777682352372,"version":"3.51.4"},"reference-count":34,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2017,6,16]],"date-time":"2017-06-16T00:00:00Z","timestamp":1497571200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000276","name":"Department of Health","doi-asserted-by":"publisher","award":["700071"],"award-info":[{"award-number":["700071"]}],"id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Health Serv Res Policy"],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Policy makers in England advocate referral of patients with suspected dementia to Memory Assessment Services (MAS), but it is unclear how any improvement in patients\u2019 health-related quality of life (HRQL) compares with the associated costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate the cost-effectiveness of MAS for the diagnosis and follow-up care of patients with suspected dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We analysed observational data from 1318 patients referred to 69 MAS, and their lay carers (n\u2009=\u2009944), who completed resource use and HRQL questionnaires at baseline, three and six months. We reported mean differences in HRQL (disease-specific DEMQOL and generic EQ-5D-3L), quality-adjusted life years (QALYs) and costs between baseline and six months after referral to MAS. We also assessed the cost-effectiveness of MAS across different patient subgroups and clinic characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Referral to MAS was associated with gains in DEMQOL (mean gain: 3.48, 95% confidence interval: 2.84 to 4.12), EQ-5D-3L (0.023, 0.008 to 0.038) and QALYs (0.006, 0.002 to 0.01). Mean total cost over six months, assuming a societal perspective, was \u00a31899 (\u00a31277 to \u00a32539). This yielded a negative incremental net monetary benefit of \u2212\u00a31724 (\u2212\u00a32388 to \u2212\u00a31085), assuming NICE\u2019s recommended willingness-to-pay threshold (\u00a330,000 per QALY). These base case results were relatively robust to alternative assumptions about costs and HRQL. There was some evidence that patients aged 80 or older benefitted more from referral to MAS (p\u2009&lt;\u20090.01 from adjusted mean differences in net benefits) compared to younger patients. MAS with over 75 new patients a month or cost per patient less than \u00a32500 over six months were relatively more cost-effective (p\u2009&lt;\u20090.01) than MAS with fewer new monthly patients or higher cost per patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Diagnosis, treatment and follow-up care provided by MAS to patients with suspected dementia appears to be effective, but not cost-effective, in the six months after diagnosis. Longer term evidence is required before drawing conclusions about the cost-effectiveness of MAS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1355819617714816","type":"journal-article","created":{"date-parts":[[2017,6,17]],"date-time":"2017-06-17T02:45:39Z","timestamp":1497667539000},"page":"226-235","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Cost-effectiveness of Memory Assessment Services for the diagnosis and early support of patients with dementia in England"],"prefix":"10.1177","volume":"22","author":[{"given":"Manuel","family":"Gomes","sequence":"first","affiliation":[{"name":"Assistant Professor of Health Economics, Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Pennington","sequence":"additional","affiliation":[{"name":"Senior Lecturer in Health Economics, King\u2019s Health Economics, King\u2019s College London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raphael","family":"Wittenberg","sequence":"additional","affiliation":[{"name":"Associate Professorial Research Fellow, Personal Social Services Research Unit, London School of Economics and Political Science, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Knapp","sequence":"additional","affiliation":[{"name":"Professor of Social Policy, Department of Social Policy, London School of Economics and Political Science, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Black","sequence":"additional","affiliation":[{"name":"Professor of Health Services Research, Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Smith","sequence":"additional","affiliation":[{"name":"Associate Professor in Psychology, Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2017,6,16]]},"reference":[{"key":"bibr1-1355819617714816","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2010.01.010"},{"key":"bibr2-1355819617714816","unstructured":"Prince M, Knapp M, Guerchet M, et\u00a0al.\n                      Dementia UK: second edition \u2013 overview\n                      . London: Alzheimer's Society, 2014."},{"key":"bibr3-1355819617714816","unstructured":"Department of Health. A state of the nation report on dementia care and support in England, www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/262139\/Dementia.pdf2013 (accessed 2 October 2016)."},{"key":"bibr4-1355819617714816","doi-asserted-by":"publisher","DOI":"10.1002\/gps.2191"},{"key":"bibr5-1355819617714816","unstructured":"Department of Health. Memory assessment service specifications, http:\/\/dementia.dh.gov.uk\/memory-assessment-service-specifications\/2011 (accessed 5 April 2017)."},{"key":"bibr6-1355819617714816","first-page":"20","volume":"82","author":"Greening L","year":"2009","journal-title":"Community Pract"},{"key":"bibr7-1355819617714816","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2010.03130.x"},{"key":"bibr8-1355819617714816","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4380"},{"key":"bibr9-1355819617714816","doi-asserted-by":"publisher","DOI":"10.1002\/gps.1741"},{"key":"bibr10-1355819617714816","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0079797"},{"key":"bibr11-1355819617714816","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c2466"},{"key":"bibr12-1355819617714816","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610215000149"},{"key":"bibr13-1355819617714816","doi-asserted-by":"publisher","DOI":"10.1192\/pb.bp.113.044263"},{"key":"bibr14-1355819617714816","doi-asserted-by":"crossref","unstructured":"Park M, Smith SC, Neuburger J, et\u00a0al. Socio-demographic characteristics, cognitive function and health-related quality of life of patients referred to Memory Assessment Services in England Alzheimer Disease and Associated Disorders. 2017; 31: 169\u2013167.","DOI":"10.1097\/WAD.0000000000000166"},{"key":"bibr15-1355819617714816","doi-asserted-by":"crossref","unstructured":"Park M, Smith SC, Chrysanthaki T, et\u00a0al. Change in health-related quality of life of patients at 6 months after referral to Memory Assessment Services.\n                      Alzheimer Dis Assoc Disord\n                      . Epub ahead of print 28 February 2017. DOI: 10.1097\/WAD.0000000000000190.","DOI":"10.1097\/WAD.0000000000000190"},{"key":"bibr16-1355819617714816","doi-asserted-by":"crossref","unstructured":"Pennington M, Gomes M, Chrysanthaki T, et\u00a0al. The cost of diagnosis and early support in patients with cognitive decline.\n                      Int J Geriatr Psych\n                      . Epub ahead of print 22 December 2016. 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NHS Reference Costs 2013 to 2014, www.gov.uk\/government\/publications\/nhs-reference-costs-2013-to-20142014 (accessed 3 October 2016)."},{"key":"bibr26-1355819617714816","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2010.00700.x"},{"key":"bibr27-1355819617714816","doi-asserted-by":"crossref","unstructured":"Rubin DB.\n                      Multiple imputation for nonresponse in surveys\n                      . New York: Wiley, 1987.","DOI":"10.1002\/9780470316696"},{"key":"bibr28-1355819617714816","unstructured":"van Buuren S. Multiple imputation of multilevel data. In: Hox J and Roberts K (eds)\n                      The handbook of advanced multilevel analysis\n                      . 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