Data presented at AICC shows new iPad-based dementia testing reduces diagnostic costs in UK GP surge Posted on 14 July 2014

Data from two studies presented this week at the Alzheimer's Association International Conference in Copenhagen (AAIC 2014, 12 - 17 July) highlight the potential major cost savings UK GP practices could achieve by using an iPad-based test for patients who present with Subjective Memory Complaints (SMC). The Cantab Mobile test developers, Cambridge Cognition, believe this represents a major step forward in devising cost-effective strategies to deal with the growing global dementia crisis.

Cantab Mobile is a quick and easy to administer iPad test that can detect the earliest clinically-relevant signs of memory loss associated with dementia.  An audio soundtrack, available in 20 languages, talks patients through each step allowing assessments to be carried out by nurses and support staff to help minimise GP consultation times.  A patient's test results are automatically scored, compared with performance expected for age, gender and education, and reported with a full audit trail.  The test has been designed to sensitively detect amnestic mild cognitive impairment and identify the earliest signs of clinically relevant memory problems associated with Alzheimer's disease. 

The first study shows that by routinely using Cantab Mobile, UK practices can reduce diagnostic costs by 40%, from a calculated average of £42,210 per cohort of 100 SMC patients to £25,666 [1]. The second study compares Cantab Mobile with two popular pencil and paper tests currently used within primary care to assess cognitive impairment and concludes the potential cost savings are directly linked to its improved test sensitivity and specificity [2].

The studies used the latest economic models developed by researchers at Cambridge Cognition and leading international health economists from York Health Economic Consortium, University of York using data from published literature and cost sources.  Starting with the assumption that GPs were following current NHS clinical guidelines and the NHS reference cost for the dementia diagnostic pathway, the researchers estimated that 47% of all patients presenting with SMC are likely to be 'worried well' and 15% to have depression, not dementia.  They then calculated the economic impact of GP practices using Cantab Mobile, which is unique in using three tests within a single assessment to differentiate between early Alzheimer's disease, MCI, depression and control patients with 98% accuracy [3].

The second study compares the test's sensitivity and specificity against two alternative paper-based tests: MMSE and GPCOG and again shows that a more sensitive and specific assessment such as Cantab Mobile has the potential to deliver considerable cost savings, as well as supporting a more accurate primary care triage of cognition, reversible causes and depression.

"We believe these two studies clearly demonstrate the health economic benefits of more accurate and appropriate primary care triage using Cantab Mobile of possible dementia cases in the UK. They should also provide a timely boost to healthcare providers as they attempt to plan viable and affordable strategies to support an ageing population.  Indeed feedback from the increasing number of UK regions using Cantab Mobile, indicates that numerous GP practices are already saving costs, making more informed referrals to memory clinics and being able to offer appropriate reassurance or treatment to patients who do not require referral," said Dr Becky Rous, clinical psychologist at Cambridge Cognition who presented these latest research findings.

Following initial trials in 2013, Cantab Mobile is now being increasingly specified and used by GP practices, pharmacies and other healthcare providers as an invaluable tool to help improve dementia diagnosis.  Doncaster is one of the latest UK regions to start using this new approach: an initial pilot with two GP practices within Doncaster Clinical Commissioning Group proved so successful that Cantab Mobile was extended to a further 24 practices from 1 July [4].

Notes and References

1          Link to PDF file of technical poster:
'Modelling the economic impact of Cantab Mobile use in UK primary care in the dementia diagnosis pathway'.
http://www.cambridgecognition.com/file-uploads/Final_Poster_Housden_Model_UK_primary_care-pp070714-iii.pdf

2          Link to PDF file of technical poster:
'The sensitivity and specificity of computerised or paper and pencil cognitive assessments used in primary care impacts the cost-effectiveness of the dementia diagnostic pathway'.
http://www.cambridgecognition.com/file-uploads/Poster_Rous_SensSpec_cog_Ax.pdf

3          Swainson R, Hodges JR, Galton CJ et al., Early detection and differential diagnosis of Alzheimer's disease and depression with neuropsychological tasks. Dement Geriatr Cogn Disord 2001; 12(4):265-280.

4          New screening tool improves dementia diagnosis (announced 16 June 14)
http://www.rdash.nhs.uk/30437/new-screening-tool-improves-dementia-diagnosis/

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