LETTER TO THE EDITOR

Music interventions against agitated behaviour in elderly persons with dementia: a cost-effective perspective
We read with interest the paper by Lin et al. (2011) on the positive effect of music intervention against agitated behaviour in patients with dementia, and we are extremely satised because their data conrm recent ndings by our group (Raglio et al., 2008; Raglio et al., 2010). We would like to discuss the point suggested by authors regarding the possibility that nursing facilities for patients with dementia adopt group music intervention as a routine institutional activity. In fact, while from the clinical point of view, the intervention is certainly useful in reducing agitated behaviours, we are concerned about economical sustainability of such interventions. Lin et al. performed 12 sessions of group music intervention involving 49 residents affected by dementia from three different nursing homes. The authors did not indicate how many patients were included in each group music intervention, although we can hypothesize (as it was in our studies) (Raglio et al., 2008; Raglio et al., 2010) they were no more than 34 per group. If we calculate a cost of 25 euros for each session of music intervention, that represents the average cost in Italy, we obtain a total cost of 300 euros for 12 sessions. Hence, considering that the total number of participants (49 in the study by Lin et al.) could be divided in groups of 34 patients per session, we obtain an overall cost of 3600 euro per 12 sessions per 12 groups, with a corresponding cost of about 74 euros for each patient. Calculating that the effect on agitated behaviours lasts at least 50 days (from the 6th session to 1 month after cessation of the intervention), we may indicate a cost of about 1,40 euro for each day of effective intervention. Hence, considering that in our country, the daily cost for each resident in nursing home ranges between 70 and 100 euro, we can estimate that the music intervention is equivalent to 1/70th of the daily cost of care. On the basis of these calculations, we may conclude that the intervention deserves attention by directors of nursing facilities in light of the large number of patient affected by dementia and behavioural and psychological symptoms of dementia (BPSD). In particular, we suggest that further studies will compare the costs of music intervention and drugs commonly used to alleviate BPSD. For example, a treatment with 2.5 mg daily olanzapine costs about 60 cents, that is, a comparable charge of money with respect to music therapy. In conclusion, we deeply appreciate the contribution of Lin and colleagues increasing the interest towards music therapy and BPSD. We hope that future investigations will contribute to clarify this complex research area. Conict of interest None declared. References
Lin Y, Chu H, Yang CY, Chen CH, Chen SG, Chang HJ, Hsieh CJ, Chou KR. 2011. Effectiveness of group music intervention against agitated behavior in elderly persons with dementia. Int J Geriatr Psychiatry 26: 670678. Raglio A, Bellelli G, Tracante D, Gianotti M, Ubezio MC, Villani D, Trabucchi M. 2008. Efcacy of music therapy in the treatment of behavioral and psychiatric symptoms of dementia. Alzheimer Dis Assoc Disord 22: 15862. Raglio A, Bellelli G, Tracante D, Gianotti M, Ubezio MC, Gentile S, Villani D, Trabucchi M. 2010. Efcacy of music therapy treatment based on cycles of sessions: a randomised controlled trial. Aging Ment Health 14: 900904.

G BELLELLI1, A RAGLIO2 AND M TRABUCCHI3 Department of Clinical and Preventive Medicine, University of Milano-Bicocca and Geriatric Clinic, S. Gerardo Hospital, Monza; Department of Rehabilitation and Aged Care, Ancelle della Carit Hospital, Cremona and Geriatric Research Group, Brescia, Italy 2 Sospiro Foundation, Cremona, Italy and Interdem Group (Psycho-Social Interventions in Dementia), Cremona, Italy 3 Rome and Geriatric Research Group, Tor Vergata University, Brescia, Italy
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Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/gps.2775

Copyright # 2011 John Wiley & Sons, Ltd.

Int J Geriatr Psychiatry 2012; 27: 327.