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.
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 d...
| Publicado en: | Age & Ageing Vol. 55; no. 6; pp. 1 - 12 |
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| Autores principales: | , , , , , , , , , |
| Formato: | Artículo |
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Oxford University Press / USA
Jun2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=195099724&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 195099724 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Jun2026 vid: 55 iid: 6 pid: 622 pub: Oxford University Press / USA artinfo: ui: 195099724 10.1093/ageing/afag176 ppf: 1 ppct: 11 formats: tig: atl: 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. aug: au: Demnitz-King, Harriet Cooper, Claudia Poppe, Michaela Budgett, Jessica Alberts, Sweedal Duffy, Larisa Adeleke, Mariam Barber, Julie Aguirre, Elisa Brodaty, Henry affil: Centre for Psychiatry and Mental Health, Queen Mary University of London, London, UK Division of Psychiatry, University College London, London, UK Division of Psychology and Language Sciences, University College London, London, UK Department of Statistical Science, University College London, London, UKPriment Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia su: Lifestyles Cost effectiveness Medical technology Behavior Randomized controlled trials Adults Dementia risk factors Dementia prevention Psychological resilience Research funding Statistical sampling Questionnaires Descriptive statistics Odds ratio Research Confidence intervals Data analysis software sug: subj: Lifestyles Cost effectiveness Medical technology Behavior Randomized controlled trials Adults Medical, Dental, and Hospital Equipment and Supplies Merchant Wholesalers Surgical Appliance and Supplies Manufacturing Surgical and Medical Instrument Manufacturing Marketing Research and Public Opinion Polling Dementia risk factors Dementia prevention Psychological resilience Research funding Statistical sampling Questionnaires Descriptive statistics Odds ratio Research Confidence intervals Data analysis software keyword: aged behavioral change cognition community copyrightHolder:British Geriatrics Society copyrightYear:2026 cost effectiveness dementia dementia prevention economics follow-up health economics https://dx.doi.org/10.1093/ageing/afag176 inLanguage:en life style malus non-pharmacological older people prevention psychological publisher:Oxford University Press quality-adjusted life years randomization resilience sameAs:https://pubmed.ncbi.nlm.nih.gov/42328805/ trees (plant) aged behavioral change cognition community copyrightHolder:British Geriatrics Society copyrightYear:2026 cost effectiveness dementia dementia prevention economics follow-up health economics https://dx.doi.org/10.1093/ageing/afag176 inLanguage:en life style malus non-pharmacological older people prevention psychological publisher:Oxford University Press quality-adjusted life years randomization resilience sameAs:https://pubmed.ncbi.nlm.nih.gov/42328805/ trees (plant) ab: 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. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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