***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Cognitive Stimulation Therapy ( CST ) is effective and cost-effective for people with mild-to-moderate dementia when delivered biweekly over 7 weeks . AIMS To examine whether longer-term ( maintenance ) CST is cost-effective when added to usual care . METHODS Cost-effectiveness analysis within multicenter , single-blind , pragmatic r and omized controlled trial ; subgroup analysis for people taking acetylcholinesterase inhibitors ( ACHEIs ) . A total of 236 participants with mild-to-moderate dementia received CST for 7 weeks . They were r and omized to either weekly maintenance CST added to usual care or usual care alone for 24 weeks . RESULTS Although outcome gains were modest over 6 months , maintenance CST appeared cost-effective when looking at self-rated quality of life as primary outcome , and cognition ( MMSE ) and proxy-rated quality -adjusted life years as secondary outcomes . CST in combination with ACHEIs  offered cost-effectiveness gains when outcome was measured as cognition . CONCLUSIONS Continuation of CST is likely to be cost-effective for people with mild-to-moderate dementia Background : Recommendations in the UK suggest restricting treatment of Alzheimer ’s disease with cholinesterase inhibitors , on cost-effectiveness grounds , to patients with moderate cognitive decline . As the economic analyses that informed these recommendations have been the subject of debate , we sought to address the potential limitations of existing models and produce estimates of donepezil treatment cost effectiveness in the UK using the most recent available data and simulation techniques . Methods : A discrete-event simulation was developed that predicts progression of Alzheimer ’s disease through correlated changes in cognition , behavioural disturbance and function . Patient-level data from seven r and omized , placebo-controlled donepezil trials and a 7-year follow-up registry provided the basis for modeling longitudinal outcomes . Individuals in the simulation were assigned unique demographic and clinical characteristics and then followed for 10 years , with severity of disease tracked on continuous scales . Patient mix and costs were developed from UK-specific literature . Analyses were run for severity subgroups to evaluate outcomes for sub- population s with disease of mild versus moderate severity from both a healthcare payer and societal perspective . All costs are reported in £ , year 2007 values , and all outcomes are discounted at 3.5 % per annum . Results : Over 10 years , treatment of all patients with mild to moderate disease  reduces overall direct medical costs by an average of over £ 2300 per patient . When unpaid caregiver time is also taken into consideration , savings increase to over £ 4700 per patient . Compared with untreated patients , patients receiving donepezil experience a discounted gain in QALYs averaging 0.11 , with their caregivers gaining , on average , 0.01 QALYs . For the subset of patients starting treatment with more severe disease , savings are more modest , averaging about £ 1600 and £ 3750 from healthcare and societal perspectives , respectively . In probabilistic sensitivity analyses , donepezil dominated no treatment between 57 % and 62 % of replications when only medical costs were considered , and between 74 % and 79 % of replications when indirect costs were included , with results more favourable for treatment initiation in the mild versus moderate severity stages of the disease . Conclusions : Although the simulation results are not definitive , they suggest that donepezil leads to health benefits and cost savings when used to treat mild to moderately severe Alzheimer ’s disease in the UK . They also indicate that both benefits and savings may be greatest when treatment is started while patients are still in the mild stages of Alzheimer ’s disease Objective To assess the cost utility of early psychosocial intervention for patients with Alzheimer 's disease and their primary caregivers . Design Cost utility evaluation alongside a multicentre , r and omised controlled trial with 3 years of follow-up . Setting Primary care and memory clinics in five Danish districts . Participants 330 community-dwelling patients and their primary caregivers . Intervention Psychosocial counselling and support lasting 8–12 months after diagnosis and follow-up at 3 , 6 , 12 and 36 months in the intervention group or follow-up only in the control group . Main outcome measures The primary outcome measure was the cost of additional quality -adjusted life years ( QALYs ) . Costs were measured from a societal perspective , including the costs of healthcare , social care , informal care and production loss . QALYs were estimated separately for the patient and the caregiver before aggregation for the main analysis . Results None of the observed cost and QALY measures were significantly different between the intervention and control groups , although a tendency was noted for psychosocial care leading to cost increases with informal care that was not outweighed by the tendency for cost savings with formal care . The probability of psychosocial intervention being cost-effective did not exceed 36 % for any threshold value . The alternative scenario analysis showed that the probability of cost-effectiveness increased over the range of threshold values used if the cost perspective was restricted to formal healthcare . Conclusions A multifaceted , psychosocial intervention programme was found unlikely to be cost-effective from a societal perspective . The recommendation for practice in setting s that are similar to the Danish setting is to provide follow-up with referral to available local support programmes when needed , and to restrict large multifaceted intervention programmes to patients and caregivers with special needs until further evidence for cost-effectiveness emerges . Trial registration The study was registered in the Clinical Trial Data base as IS RCT N74848736 Objective Most investigations of pharmacotherapy for treating Alzheimer 's disease focus on patients with mild‐to‐moderate symptoms , with little evidence to guide clinical decisions when symptoms become severe . We examined whether continuing donepezil , or commencing memantine , is cost‐effective for community‐dwelling , moderate‐to‐severe Alzheimer 's disease patients . Methods Cost‐effectiveness analysis was based on a 52‐week , multicentre , double‐blind , placebo‐controlled , factorial clinical trial . A total of 295 community‐dwelling patients with moderate/severe Alzheimer 's disease , already treated with donepezil , were r and omised to : ( i )  continue donepezil ;  (  ii ) discontinue donepezil ;  ( iii ) discontinue donepezil and start memantine ; or ( iv ) continue donepezil and start memantine . Results Continuing donepezil for 52 weeks was more cost‐effective than discontinuation , considering cognition , activities of daily living and health‐related quality of life .  Starting memantine was more cost‐effective than donepezil discontinuation . Donepezil – memantine combined is not more cost‐effective  than donepezil alone . Conclusions Robust evidence is now available to inform clinical decisions and commissioning strategies so as to improve patients ' lives whilst making efficient use of available re sources . Clinical guidelines for treating moderate/severe Alzheimer 's disease , such as those issued by NICE in Engl and and Wales , should be revisited . © 2016 The Authors . International Journal of Geriatric Psychiatry published by John Wiley & Sons BACKGROUND  Informal ( dementia ) care  has economic consequences throughout the health care system . Whilst the health and wellbeing of the care recipient might improve , the health of the caregiver might also change , typically for the worse . Therefore , this analysis aims to examine the association between caregiving intensity and caregivers '  health and health care utilization . DATA AND METHODS The empirical analysis is based on cross-sectional survey data generated by the European Project " RightTimePlaceCare "  ( RTPC ) . RTPC was a prospect i ve cohort study conducted in eight European countries ( Estonia , Finl and , France , Germany , Netherl and s , Sweden , Spain and the United Kingdom ) . The health status of 1029 informal caregivers was assessed by measures of  psychological wellbeing ( GHQ-12 ) and self-rated overall health ( EQ-VAS ) . Health care utilization was measured by ( i ) the self-stated proportion of health care use influenced by caregiving and ( ii ) the probability of at least one visit to a general practitioner within in the last 30 days . The association between caregiving intensity and caregivers ' health and health care utilization was assessed by descriptive analysis and multivariate OLS- and probit-models . RESULTS A higher amount of informal care was significantly related to negative health outcomes for informal caregivers . On average , one additional hour of informal caregiving per day was associated with a decrease of psychological wellbeing and self-rated overall health by 0.16 and 0.42 index points respectively . Furthermore , one more hour of informal caregiving corresponded with increased self-stated proportion of health care use by 0.56 percentage points . However , the cl aim of increased health care dem and due to caregiving as measured by GP visits was only partly confirmed . CONCLUSION When evaluating the full economic effect of informal care , the impact of providing care on caregivers ' health and health care utilization has to be taken into account BACKGROUND Depression is a common and costly comorbidity in dementia . There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes . AIMS To evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia . METHOD A pragmatic , multicentre , r and omised placebo-controlled trial with a parallel cost-effectiveness analysis ( trial registration : IS RCT N88882979 and EudraCT 2006 - 000105 - 38 ) . The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline , mirtazapine or placebo  with differences in effectiveness measured by the primary outcome , total Cornell Scale for Depression in Dementia ( CSDD ) score , over two time periods : 0 - 13 weeks and 0 - 39 weeks . The secondary evaluation was a cost-utility analysis using quality -adjusted life years ( QALYs ) computed from the Euro-Qual ( EQ-5D ) and societal weights over those same periods . RESULTS There were 339 participants r and omised and 326 with costs data ( 111 placebo , 107 sertraline , 108 mirtazapine ) . For the primary outcome , decrease in depression , mirtazapine and sertraline were not cost-effective compared with placebo . However , examining secondary outcomes , the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo ( 6.74 v. 12.27 hours per week ) or sertraline ( 6.74 v. 12.32 hours per week ) . Informal care costs over 39 weeks were £ 1510 and £ 1522 less for the mirtazapine group compared with placebo and sertraline respectively . CONCLUSIONS In terms of reducing  depression  , mirtazapine and sertraline were not cost-effective for treating depression in dementia . However , mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome . Unpaid ( family ) carer costs were lower with mirtazapine than sertraline or placebo . This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety . Given the priority and the potential value of supporting family carers of people with dementia , further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers CONTEXT Because of the increasing number of elderly people with dementia , the costs of dementia and dementia care are expected to grow rapidly in the coming decades . Cost-effectiveness results are relevant for decision making about new strategies in dementia care . OBJECTIVE To evaluate the cost-effectiveness of an integrated multidisciplinary diagnostic facility for diagnosing dementia in ambulatory psychogeriatric patients . DESIGN R and omized controlled trial with an economic evaluation component . SETTING The Maastricht Evaluation of a Diagnostic Intervention for Cognitively Impaired Elderly , Maastricht University Hospital , Maastricht , the Netherl and s. PATIENTS A total of 137 patients who received care in the multidisciplinary diagnostic facility and 93 who received usual care .  MAIN OUTCOME MEASURES Quality -adjusted life-years ( QALYs ) as the main outcome measure and cognition and behavioral problems as secondary outcome measures . RESULTS Compared with patients receiving usual care , patients who visited the diagnostic facility gained a mean 0.05 QALY at the extra cost of euro65 . The incremental cost per QALY amounted to euro1267 . This point estimate lies beneath commonly accepted thresholds and is within an acceptable range of uncertainty . With regard to the secondary analyses , cost-effectiveness results showed a substantial amount of uncertainty and were therefore indecisive . CONCLUSION On the basis of the main cost-per-QALY analysis , the use of the integrated multidisciplinary diagnostic facility is cost-effective for the diagnosis and management of dementia in ambulatory patients BACKGROUND Group cognitive stimulation therapy programmes can benefit cognition and quality of life for people with dementia . Evidence for home-based , carer-led cognitive stimulation interventions is limited . OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of carer-delivered individual cognitive stimulation therapy ( iCST ) for people with dementia and their family carers , compared with treatment as usual ( TAU ) . DESIGN A multicentre , single-blind , r and omised controlled trial assessing clinical effectiveness and cost-effectiveness . Assessment s were at baseline , 13 weeks and 26 weeks ( primary end point ) . SETTING Participants were recruited through 
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Conclusions Social costs can substantially modify the results of the economic evaluations .