Dementia case management effectiveness on health care costs and resource utilization: a systematic review of randomized controlled trials

The growing number of dementia patients leads to both policy, economic and health organization constraints. Many healthcare systems have developed case management programs in order to optimize dementia patients and caregivers care and services delivery. Nevertheless, to what extend case management programs can lead to an improvement of care and expenditures savings is not known. Thus, the objective of this paper was to analyse the efficacy of case management programs on health care cost, institutionalization and hospitalization. A systematic review of randomized controlled trials was therefore conducted of the databases MEDLINE and SCOPUS up to September 2009. Included were English language randomized controlled trials of case management for community dwelling dementia patients and their caregivers evaluating costs, institutionalization and hospitalization. An evaluation of the methodological quality was performed. Thirteen relevant studies concerning 12 trials were identified and included. None of the 7 low quality studies reported positive impact of case management on the outcomes of interest. Among the 6 good quality studies, 4 reported positive impact on institutionalization delay, institutionalization length or nursing home admission rate. In none of the good quality studies was evidence found for savings in health care expenditures or reduction in hospitalization recourse. The weak convincing evidences from randomized trials do not allow any conclusion about the efficacy of case management for dementia patient and caregivers on costs and resource utilization. Further research should focus on determining subgroups of caregivers who could benefit the most from case management.