Cost-Benefit Analysis of the COPE Program for Persons Living With Dementia: Toward a Payment Model

Laura T Pizzi, Eric Jutkowitz, Katherine M Prioli, Ember Yiwei Lu, Zachary Babcock, Heather McAbee-Sevick, Dorothy B Wakefield, Julie Robison, Sheila Molony, Catherine V Piersol, Laura N Gitlin, Richard H Fortinsky, Laura T Pizzi, Eric Jutkowitz, Katherine M Prioli, Ember Yiwei Lu, Zachary Babcock, Heather McAbee-Sevick, Dorothy B Wakefield, Julie Robison, Sheila Molony, Catherine V Piersol, Laura N Gitlin, Richard H Fortinsky

Abstract

Background and objectives: There is a critical need for effective interventions to support quality of life for persons living with dementia and their caregivers. Growing evidence supports nonpharmacologic programs that provide care management, disease education, skills training, and support. This cost-benefit analysis examined whether the Care of Persons with Dementia in their Environments (COPE) program achieves cost savings when incorporated into Connecticut's home- and community-based services (HCBS), which are state- and Medicaid-funded.

Research design and methods: Findings are based on a pragmatic trial where persons living with dementia and their caregiver dyads were randomly assigned to COPE with HCBS, or HCBS alone. Cost measures included those relevant to HCBS decision makers: intervention delivery, health care utilization, caregiver time, formal care, and social services. Data sources included care management records and caregiver report.

Results: Per-dyad mean cost savings at 12 months were $2 354 for those who received COPE with a mean difference-in-difference of -$6 667 versus HCBS alone (95% CI: -$15 473, $2 734; not statistically significant). COPE costs would consume 5.6%-11.3% of Connecticut's HCBS annual spending limit, and HCBS cost-sharing requirements align with participants' willingness to pay for COPE.

Discussion and implications: COPE represents a potentially cost-saving dementia care service that could be financed through existing Connecticut HCBS. HCBS programs represent an important, sustainable payment model for delivering nonpharmacological dementia interventions such as COPE.

Keywords: Health care policy; Health economics; Home- and community-based services; Medicaid/Medicare; Pragmatic trial.

© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America.

Figures

Figure 1.
Figure 1.
Univariate sensitivity analyses of COPE intervention costs.Note: APN = advanced practice nurse; COPE = Care of Persons with Dementia in their Environments; OT = occupational therapist.

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