Three studies in this review evaluated costs. The MADDE demonstration resulted in reduced Medicare expenditures of $500 on average, which did not offset the costs of the program (Fox et al., 2000). Participants had a 20 percent copayment, but there were no substantial cost containment incentives to encourage more efficient use of LTSS. The VA/Alzheimer's Association's PDC program found that there were no differences in VA health care expenditures between those in the program and those in the comparison group (AHRQ, 2012). However, there were reduced costs among a small number of outlying high-cost veterans. The other study that evaluated costs was the Lewisham, United Kingdom, study described by Challis et al. (2002). In that study, the intervention group spent more on social services and medical care compared to controls, but overall, there was no difference in costs to society between the two arms.