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Dementia care in the general practice setting: a cluster randomized trial on the effectiveness and cost impact of three management strategies


Menn, Petra, Holle, Rolf, Kunz, Simone, Donath, Carolin, Lauterberg, Jörg, Leidl, Reiner, Marx, Peter, Mehlig, Hilmar, Ruckdäschel, Stephan, Vollmar, Horst Christian, Wunder, Sonja, Gräßel, Elmar


Value In Health: The Journal Of The International Society For Pharmacoeconomics And Outcomes Research, Volume: 15, No.: 6, Pages.: 851-859

Year of Publication



Objective: To compare a complex nondrug intervention including actively approaching counseling and caregiver support groups with differing intensity against usual care with respect to time to institutionalization in patients with dementia.; Methods: Within this three-armed cluster-randomized controlled trial, 390 community-dwelling patients aged 65 years or older with physician-diagnosed mild to moderate dementia and their caregivers were enrolled via 129 general practitioners in Middle Franconia, Germany. The intervention included general practitioners’ training in dementia care and their recommendation of support groups and actively approaching caregiver counseling. Primary study end point was time to institutionalization over 2 years. In addition, long-term intervention effects were assessed over a time horizon of 4 years. Secondary end points included cognitive functioning, (instrumental) activities of daily living, burden of caregiving, and health-related quality of life after 2 years. Frailty models with strict intention-to-treat approach and mixed linear models were applied to account for cluster randomization. Health care costs were assessed from the societal perspective.; Results: After 2 (4) years, 12% (24%) of the patients were institutionalized and another 21% (35%) died before institutionalization. No significant differences between study groups were observed with respect to time to institutionalization after 2 and 4 years (P 0.25 and 0.71, respectively). Secondary end points deteriorated, but differences were not significant between study groups. Almost 80% of the health care costs were due to informal care. Total annual costs amounted to more than €47,000 per patient and did not differ between study arms.; Conclusion: The intervention showed no effects on time to institutionalization and secondary outcomes.; Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Bibtex Citation

@article{Menn_2012, doi = {10.1016/j.jval.2012.06.007}, url = {}, year = 2012, month = {sep}, publisher = {Elsevier {BV}}, volume = {15}, number = {6}, pages = {851--859}, author = {Petra Menn and Rolf Holle and Simone Kunz and Carolin Donath and Jörg Lauterberg and Reiner Leidl and Peter Marx and Hilmar Mehlig and Stephan Ruckdäschel and Horst Christian Vollmar and Sonja Wunder and Elmar Grä{ss}el}, title = {Dementia Care in the General Practice Setting: A Cluster Randomized Trial on the Effectiveness and Cost Impact of Three Management Strategies}, journal = {Value in Health} }


aged, aged, 80 and over, caregivers, cluster analysis, comparative effectiveness research, counselling, dementia, disease management, female, general practice, germany, humans, male, models theoretical, nursing, physiopathology

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Cost and service use study, Randomised Controlled Trial

Type of Outcomes

ADLs/IADLs, Carer Burden (instruments measuring burden), Cognition, Quality of Life of Person With Dementia, Service use or cost reductions (incl. hospital use reduction, care home admission delay)



Type of Interventions

Intervention for Carers

Carer Focussed Interventions

Other, Peer Support