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Cost-utility analysis of the DREAMS START intervention for people living with dementia and their carers: a within-trial economic evaluation
Gonzalez L, Rapaport P, Livingston G, Amador S, Adeleke MO, Barber JA, et al.. The Lancet Healthy Longevity, 2025-05-21
Topic: Risk, prevention and care in population studies
We aimed to conduct a cost-utility analysis of DREAMS START compared with treatment as usual (TAU). The mean incremental difference in health and personal social services costs was £59 less per dyad (95% CI -5168 to 5050) and, when incorporating wider societal costs, was £116 less per dyad (-5769 to 5536) for the intervention group than the TAU group, although these figures were non-significant. The mean incremental difference in QALYs per person with dementia was 0·016 more (95% CI 0·000 to 0·033) for the intervention group than for the TAU group, indicating no significant difference in quality of life. At a £20 000 per QALY gained decision threshold, there was a 78% probability that DREAMS START is cost-effective, compared with TAU.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Gonzalez, L., Rapaport, P., Livingston, G., Amador, S., Adeleke, M. O., Barber, J. A., et al. (2025). Cost-utility analysis of the DREAMS START intervention for people living with dementia and their carers: a within-trial economic evaluation. The Lancet Healthy Longevity. https://doi.org/10.1016/j.lanhl.2025.100708
Vancouver
Gonzalez L, Rapaport P, Livingston G, Amador S, Adeleke MO, Barber JA, et al. Cost-utility analysis of the DREAMS START intervention for people living with dementia and their carers: a within-trial economic evaluation. The Lancet Healthy Longevity. 2025. doi:10.1016/j.lanhl.2025.100708. PMID: 40412418.
BibTeX
@article{gonzalez2025-40412418,
author = {Gonzalez, L. and Rapaport, P. and Livingston, G. and Amador, S. and Adeleke, M. O. and Barber, J. A. and others},
title = {{Cost-utility analysis of the DREAMS START intervention for people living with dementia and their carers: a within-trial economic evaluation}},
journal = {The Lancet Healthy Longevity},
year = {2025},
doi = {10.1016/j.lanhl.2025.100708},
pmid = {40412418},
url = {https://doi.org/10.1016/j.lanhl.2025.100708}
}
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Key findings
- We aimed to conduct a cost-utility analysis of DREAMS START compared with treatment as usual (TAU).
- The mean incremental difference in health and personal social services costs was £59 less per dyad (95% CI -5168 to 5050) and, when incorporating wider societal costs, was £116 less per dyad (-5769 to 5536) for the intervention group than the TAU group, although these figures were non-significant.
- The mean incremental difference in QALYs per person with dementia was 0·016 more (95% CI 0·000 to 0·033) for the intervention group than for the TAU group, indicating no significant difference in quality of life.
- At a £20 000 per QALY gained decision threshold, there was a 78% probability that DREAMS START is cost-effective, compared with TAU.
Why it matters
Costs were slightly lower and quality-of-life gains were not significantly different for DREAMS START compared with treatment as usual, with a 78% probability of being cost-effective at a £20,000 per QALY threshold. This addresses cost and value of the sleep intervention, not whether it changes the course of dementia.
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Study details
- Study designRCT
- Participants377
- Effect size78% probability of cost-effectiveness at £20,000/QALY; incremental QALY 0.016 (95% CI 0.000-0.033)
- Evidence strengthModerate
Limitations
Cost and QALY differences were individually non-significant with very wide confidence intervals; UK-specific costs and thresholds; carer-proxy quality-of-life measures.
How this study scored 62/100
Published in a leading specialty journal, and it is a randomised controlled trial. We have no data on free to read, so that was left out: it earned 61 of the 98 points we could judge it on, which is 62 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (The Lancet Healthy Longevity) |
| Journal's citation record | 1 / 4 | The Lancet Healthy Longevity: journal h-index 78 (OpenAlex, 2026-10-29) |
| Study design | 11 / 12 | A randomised controlled trial |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 2 / 4 | 377 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | 1 / 7 | Cited 4 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 3.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 4 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Rachael Maree Hunter: h-index 46 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Oxford: institution h-index 2,205 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 7 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40412418) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 61 / 98 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 61 of the 98 points we could judge it on is 62 out of 100. |
| Total | 62 / 100 | — |
What each of these 20 components measures, and what this score is not →
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