November 2017
What we have achieved:
- An early economic model has been developed to reflect the costs of good quality end of life care
- A further mathematical economic model is currently being developed to further evaluate the costs and of alternative care pathways to the SEED intervention.
Members of the general public will also participate in a Willingness to Pay (WTP) survey, asking what their maximum WTP would be for scenarios describing different care pathways for end of life care in dementia. A sample of people with early dementia and their family carers will also be surveyed and asked to state their WTP.
Willingness to pay is a method for measuring strength of preference. By presenting different scenarios and asking participants how much they would hypothetically be willing to pay for each, we can find out which options are preferred. If a low willingness to pay is obtained (or if participants are not willing to pay more for the preferred option), then this indicates only a weak preference for the preferred option; in contrast, if participants are willing to pay considerably more for the preferred option, this suggests a strong preference.
This comprises two separate but related projects, WS5.1 and 5.2.
WS5.1: development of an economic model of care pathways:
- A preliminary decision analytic model has been developed in the form of a Markov tree, in which each Markov state represents an actual care setting and progresses up until the point of death. The goal is to compare the expected consequences of the designed ICP with other pathways such as the current practice, and extreme scenarios.
- The 7 factors of good quality of end of life care that have emerged from the WS2 qualitative study are treated as the developed ICP in the model. We have implicitly or explicitly incorporated aspects from all these 7 themes in order to add face validity, and to capture the impact of the ICP in costs and outcomes by varying these aspects of optimal EoLC within the model. This is in a more extensive description of the model.
- Caregiver's burden needs to be incorporated in the analysis. A parallel model to account for the impact of the ICP on caregiver's burden separately is under construction.
- Following the development of the model, a meeting with a dementia specialist from the team needs to be arranged, in order to agree on the representativeness of the economic model, the completeness of the clinical pathway, and the inclusion of caregiver's burden in the analysis.
- Economic data have been extracted from the COMPASSION study to inform economic model parameters. However, this does not cover all of the parameters necessary for cost-consequence analysis of the developed ICP. Therefore, a non-systematic search has been done to identify additional relevant data.
- Once the structure of the model is agreed, a table of data that need to inform model parameters will be created. Then a systematic search strategy will be designed to identify the necessary data to inform the parameters and conduct the analysis. Subsequently, different search methodologies will be used to identify data necessary to run the analysis.
WS5.2: this comprises a willingness to pay exercise and cost benefit analysis; a protocol for the proposed work has been completed.