Abstract
The rapidly aging population portends an increase in the prevalence of patients with cognitive impairment and its incumbent humanistic and monetary costs to the healthcare system. BrainCheck, Inc. has developed an online point-of-care technology that is intended for the assessment and management of mild cognitive impairment (MCI) and dementia. It is comprised of a battery of digital neurocognitive tests that can be administered via iPad, iPhone or computer in about 5 minutes and has been shown to have high sensitivity and specificity. We developed a 3-arm Markov decision-analytic model to estimate the comparative cost-effectiveness of BrainCheck, usual care (UC) in the community setting and UC in a skilled nursing facility (SNF). A Markov model allows a cohort to experience different “health states” (Normal, MCI, Dementia, Death) over discrete time intervals. Outcomes were reported as incremental cost-effectiveness ratios (ICERs) between the 3 arms. The outcomes metrics were cost per quality-adjusted life years (QALYs), cost per emergency room visit/hospitalization avoided, cost per SNF admission avoided and cost per incremental difference in Neuropsychiatric Inventory (NPI) score, based on a randomized controlled trial incorporating these 3 pathways. Influence of the 3 arms on quality of life was measured using both the EQ-5D and NPI. Resource use was collected via the Resource Utilisation in Dementia instrument. The model took a lifetime perspective and costs and effectiveness were discounted at 3%. Base-case analyses found that adopting BrainCheck delivered more QALYs for patients over their lifetime and was substantially more cost-effective than UC in both settings.