Cost-effectiveness of the special care unit for persons with dementia - 22/07/26

Doi : 10.1016/j.tjpad.2026.100647

Ron Handels ^1,^2,^⁎ , Bernhard Michalowsky ³, Aline Mendes ⁴, Sverre Bergh ⁵, Bruno Mario Cesana ⁶, Alfonso Ciccone ^7,⁸, Emmanuel Cognat ^9,¹⁰, Andrea Fabbo ¹¹, Sara Fascendini ¹², Giovanni B. Frisoni ¹³, Lutz Froelich ¹⁴, Patrizia Mecocci ^15,¹⁶, Paola Merlo ¹⁷, Oliver Peters ¹⁸, Magdalini Tsolaki ¹⁹, Carlo Alberto Defanti ¹⁰

RECage consortium collaborators

¹ Faculty of Health Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, P.O. box 6161, 6200 MD, Maastricht, the Netherlands

² Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 22, 171 64 Solna, Sweden

³ German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, 17487 Greifswald, Germany

⁴ Department of Readaptation and Geriatrics, University Hospitals and University of Geneva, 24 rue du Général-Dufour 1211 Geneva, Switzerland.

⁵ Research centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, P.O. box 68, 2313, Ottestad, Norway

⁶ Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics “Giulio A. Maccacaro” Faculty of Medicine and Surgery, University of Milan, Via Festa del Perdono 7 20122, Milan, Italy

⁷ Memory clinic, Department of Neurology, ASST di Mantova, Mantua, Italy

⁸ Memory Clinic, Department of Neurology, ASST di Mantova, Mantova, Italy

⁹ Université Paris Cité, 101 rue de Tolbiac, UMRS 1144, INSERM, Paris, France

¹⁰ Cognitive Neurology Center, AP-HP.Nord, Site Lariboisière Fernand-Widal, 200 Rue du Faubourg Saint-Denis, 75010, Paris, France

¹¹ Cognitive Disorders and Dementia Unit, Health Authority and Services (AUSL) of Modena, Strada Minutara Hangar 3, 41122 Modena, Italy

¹² FERB Alzheimer Centre, Ospedale Briolini, via A. Manzoni, 130, 24025 Gazzaniga, Italy

¹³ Memory Centre, Department of Readaptation and Geriatrics, University Hospitals and University of Geneva, 24 rue du Général-Dufour 1211 Geneva, Switzerland

¹⁴ Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J 5 68159 Mannheim, Germany

¹⁵ Division of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Piazza Università, 1 06123 Perugia Italy

¹⁶ NVS Department, Karolinska Institutet, Karolinska Vägen 22, 171 77 Stockholm, Sweden

¹⁷ Dept. of Neurology, Humanitas Gavazzeni, Via Mauro Gavazzeni, 21 24125, Bergamo Italy

¹⁸ Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Psychiatry, Charitéplatz 1 10117 Berlin, Germany

¹⁹ 1st Department of Neurology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Alzheimer Hellas, and Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI - AUTh), Aristotle University of Thessaloniki, 54124 Thessaloniki Hellas

^⁎ Corresponding author. Ron Handels, Faculty of Health Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Faculty of Health Medicine and Life Sciences Department of Psychiatry and Neuropsychology School for Mental Health and Neuroscience Alzheimer Center Limburg Maastricht University

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HIGHLIGHTS

•	SCU-B (special care unit for behavioral symptoms) was likely not cost-effective.
•	SCU-B widespread implementation or disinvestment cannot be recommended.
•	We recommend future studies to randomize over SCU-B and usual care.

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ABSTRACT

INTRODUCTION

We aimed to estimate the cost-effectiveness of the patient-centered special care unit for behavioral and psychological symptoms of dementia (SCU-B) in the Respectful Caring for the Agitated Elderly (RECage) study.

METHODS

A health-economic evaluation was performed alongside a controlled European multicenter three-year longitudinal cohort study enrolling 508 participants in a non-SCU-B cohort and SCU-B cohort. Health service resource use, costs, quality-adjusted life years (QALYs), and incremental cost per QALY gained were assessed.

RESULTS

Total QALYs were lower (-0.13; bootstrap-interval -0.23 to -0.02) and total costs were higher (€24,960; bootstrap-interval 14,870 to 35,090) in the SCU-B cohort. Base case and sensitivity analyses indicated the SCU-B was likely not cost-effective.

DISCUSSION

Widespread implementation as well as disinvestment of SCU-B cannot be recommended, given the uncertainty of the study results. We recommend a randomized study stratified by (local/county) region for conclusive evidence.

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KEYWORDS : Dementia, behavioral and psychological symptoms, special care unit, cost-effectiveness, health-economic evaluation