This week we will look at a cost effectiveness synthesis that included music therapy as a non-pharmocological intervention.  Livingston et al. (2014) conducted a synthesis paper in order to determine the cost-effectiveness of different sensory and behavioral interventions for agitation in adults with dementia.

Music therapy using a specific protocol was categorized with “evidence of efficacy” for decreasing agitation during the intervention in care home residents. The authors report that trained music therapists led interventions in the included studies (p. 20). They also indicate that these studies included w warm-up, listening to well-known music, and playing music. There was no evidence for long-term decreases in agitation and little evidence outside of care homes.

Music therapy without a specific protocol was categorized under “too little evidence to make definitive recommendations” (p. 17). A quick review of the studies listed in this section includes studies using recorded music – sometimes preferential, sometimes not – played during times of agitation. There were fewer studies in this category and the authors report that the studies were of lower quality.

The cost of effectiveness of services was calculated using literature that examined costs and or cost-effectiveness of interventions. Music Therapy was noted as cost effective at the price of 13-27 pounds ($22-46) for the intervention. These rates are below current US rates for intervention; however, this is an analysis of past studies (and therefore past rates). Since there a few studies that report costs, these data would be generated from a small sample of studies.

The authors also completed a cost-effectiveness analysis, where cost was calculated in consideration of per unit improvements in agitation (Pg. 62 of the report). This included studies where the Cohen-Mansfield Agitation Inventory (CMAI) was used to measure agitation. In this analysis the cost of the intervention was divided by the the change in agitation scores. Therefore, the cost reported is the incremental cost per unit reduction. Music therapy was the lowest of the interventions, at 4 pounds ($6.83) per CMAI unit. I would be interesting to see this  value calculated using current music therapy intervention rates.

I am not an expert in this type of research, so I look forward to hearing other’s opinions of this study. I appreciate that these authors took the time to separate music therapy interventions with protocols from music therapy interventions without protocols. I did some spot checking of cited articles in the both categories and found that articles in the “with protocols” category were led by trained music therapists or individuals with training in music interventions. Music therapy in the “without protocols” category was led by numerous professionals including nursing staff in my quick check. This distinction is very important, as the training of a music therapists to use protocols ensures that the patient receives services that are appropriate and will best facilitate intended outcomes. With all the excitement about playing recoded music for older adults in the popular media, this study provides some grounds for consideration of the type of services provided – with evidence of improvements for protocol-based services.

Reference:
Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, Omar RZ, Katona C, & Cooper C. (2014). A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. Health Technology Assessment, 18(39), 1-226. PMID: 24947468