Cost-effectiveness of 5-Cog paradigm for individuals with cognitive concerns in primary care

In a recent randomized clinical trial (RCT), the 5-Cog paradigm showed efficacy in detecting cognitive impairment while also increasing the frequency of relevant care actions. We sought to estimate the cost-effectiveness of the 5-Cog paradigm for dementia screening and management in primary care patients.

RCT conducted in a primary care clinic from May 2019 to September 2022. The patients were either assigned to the control or 5-Cog intervention.

Financial records for health services were obtained from electronic medical records. The primary measure of efficacy was improved dementia care actions. Cost-effectiveness analyses were conducted for both encounter-related and procedure-related costs only related to 5-Cog testing and further related care. Incremental Cost Effectiveness Ratios (ICERs) were calculated using a cost per diagnosis ratio relative to an active control arm.

A total of 1106 participants (92.8 % of study participants) were included in the analysis (mean age 72.8 years). 5-Cog participants were more likely to receive 'improved dementia care': MCI/dementia diagnosis (aOR = 19.53, p = 0.020), MRI/CT brain imaging (aOR = 29.37, p = 0.001), memory related lab orders (aOR = 43.85, p = 0.002), and specialty or community-based referrals (aOR = 4.23, p = 0.049). Total aggregated expenditures for 5-Cog patients were higher (aOR = 2.24, p < 0.001). ICERs for total aggregate costs, encounter-related costs, and procedure-related costs were $306, $212, and $94, respectively.

The results suggest that the 5-Cog paradigm is a cost-effective option for cognitive impairment screening in primary care. In concert with the original work supporting the efficacy of 5-Cog, this work further supports the candidacy of 5-Cog as a universal dementia screening tool.