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Cost utility and cost-effectiveness of the APPLE-Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce: economic evaluation embedded within a randomised controlled trial
Harriet Demnitz-King, Claudia Cooper, Michaela Poppe, Jessica Budgett, Sweedal Alberts, Larisa Duffy, Mariam Adeleke, Julie Barber, et al.. Age and ageing, 2026-06-01
Topic: Risk, prevention and care in population studies
Background Previous studies have modelled long-term cost-effectiveness of dementia prevention but seldom within trials. APPLE-Tree (Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce) is a personalised, multi-domain, low-intensity dementia prevention intervention for adults experiencing subjective cognitive decline or mild cognitive impairment. Intervention receipt, relative to control, was associated with an adjusted mean difference of 0.06 (95%CI -0.001 to -0.128) in the Neuropsychological Test Battery (NTB). We evaluated cost-effectiveness from health- and social-care perspectives over 2 years. Methods We recruited 746 older adults from English health and community settings and randomly assigned them (1:1) to APPLE-Tree plus usual care (UC) or UC plus written dementia prevention information. Quality-adjusted life-years (QALYs) were calculated from the EQ-5D-5L. Over 24-months, intention-to-treat analyses compared QALYs (primary) and incremental cost per NTB unit (one z-score) change (secondary). Results Between October 2020 and December 2022, 374 participants were randomised to intervention and 372 to control. Mean adjusted QALYs were 1.511 (intervention) and 1.520 (control), an adjusted difference of -0.010 (95%CI -0.04 to -0.022). Mean adjusted (SD) costs were £2966 (3629) and £2551 (4439), respectively. Cost per 1-point NTB change z-score was £6809. At a £30 000 threshold, the probability of cost-effective was 12% and 96% based on QALYs and cognition, respectively. Post hoc analyses indicated higher cost-effectiveness for non-White participants (incremental costs: £374; 95%CI -590.751 to -1338.515) and socioeconomically disadvantaged participants (non-homeowners), who had higher QALYs (0.106) and lower costs (-£1830), yielding a 98% probability of cost-effectiveness at a £20 000 threshold. Conclusion APPLE-Tree has a high probability of being cost-effective for a 1-point NTB gain, a difference previously associated with a three-fold reduction in 5-year dementia risk. QALY-based cost-effectiveness was not observed, but post-hoc analyses suggested it may be more effective in groups with greater needs. Findings highlight the potential of targeted, lower-intensity interventions to reduce dementia risk. Longer-term follow-up is required to determine whether cost-effectiveness is realised over time.
Key findings
- Intervention receipt, relative to control, was associated with an adjusted mean difference of 0.06 (95%CI -0.001 to -0.128) in the Neuropsychological Test Battery (NTB).
- Results Between October 2020 and December 2022, 374 participants were randomised to intervention and 372 to control.
- Conclusion APPLE-Tree has a high probability of being cost-effective for a 1-point NTB gain, a difference previously associated with a three-fold reduction in 5-year dementia risk.
Why it matters
In this economic evaluation alongside a randomized trial, the APPLE-Tree lifestyle program produced slightly lower quality-adjusted life-years than usual care and slightly higher costs. The authors conclude it has a high probability of being cost-effective for a small gain on a cognitive test score, a difference previously linked to lower dementia risk.
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Study details
- Study designRCT
- Participants746
- Effect sizeIncremental cost per 1-point NTB z-score gain: 6,809 pounds; QALY difference -0.010 (95% CI -0.04 to 0.022)
- Evidence strengthModerate
Limitations
Two-year horizon cannot capture whether cognitive gains translate into fewer dementia cases; subgroup findings were post hoc; English health and social care perspective only.
How this study scored 61/100
Published in a peer-reviewed journal, and it is a randomised controlled trial. We have no data on free to read, so that was left out: it earned 60 of the 98 points we could judge it on, which is 61 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Age and ageing) |
| Journal's citation record | 2 / 4 | Age and Ageing: journal h-index 231 (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 | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 2 / 4 | 746 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 1 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.5 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | 3 / 6 | Cited 7.4× 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 | 0 / 4 | Cited 1 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 College London: institution h-index 2,029 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 13 institution(s) in 5 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 42328805) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 60 / 98 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 60 of the 98 points we could judge it on is 61 out of 100. |
| Total | 61 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — PubMed Central lists this copy as free to read: the link above (checked 10 Oct 2026).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Demnitz-King, H., Cooper, C., Poppe, M., Budgett, J., Alberts, S., Duffy, L., et al. (2026). Cost utility and cost-effectiveness of the APPLE-Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce: economic evaluation embedded within a randomised controlled trial. Age and ageing. https://doi.org/10.1093/ageing/afag176
Vancouver
Demnitz-King H, Cooper C, Poppe M, Budgett J, Alberts S, Duffy L, et al. Cost utility and cost-effectiveness of the APPLE-Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce: economic evaluation embedded within a randomised controlled trial. Age and ageing. 2026. doi:10.1093/ageing/afag176. PMID: 42328805.
BibTeX
@article{demnitzking2026-42328805,
author = {Demnitz-King, Harriet and Cooper, Claudia and Poppe, Michaela and Budgett, Jessica and Alberts, Sweedal and Duffy, Larisa and Adeleke, Mariam and Barber, Julie and others},
title = {{Cost utility and cost-effectiveness of the APPLE-Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce: economic evaluation embedded within a randomised controlled trial}},
journal = {Age and ageing},
year = {2026},
doi = {10.1093/ageing/afag176},
pmid = {42328805},
url = {https://doi.org/10.1093/ageing/afag176}
}
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here.