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Background and ObjectiveThe prevalence of dementia is increasing, while new opportunities for diagnosing, treating and possibly preventing Alzheimer's disease and other dementia disorders are placing focus on the need for accurate estimates of costs in dementia. Considerable methodological heterogeneity creates challenges for synthesising the existing literature. This study aimed to estimate the costs for persons with dementia in Europe, disaggregated into cost components and informative patient subgroups. Methods We conducted an updated literature review searching PubMed, Embase and Web of Science for studies published from 2008 to July 2021 reporting empirically based cost estimates for persons with dementia in European countries. We excluded highly selective or otherwise biased reports, and used a random-effects meta-analysis to produce estimates of mean costs of care across five European regions. Results Based on 113 studies from 17 European countries, the estimated mean costs for all patients by region were highest in the British Isles (73,712 EUR), followed by the Nordics (43,767 EUR), Southern (35,866 EUR), Western (38,249 EUR), and Eastern Europe and Baltics (7938 EUR). Costs increased with disease severity, and the distribution of costs over informal and formal care followed a North-South gradient with Southern Europe being most reliant on informal care. Conclusions To our knowledge, this study represents the most extensive meta-analysis of the cost for persons with dementia in Europe to date. Though there is considerable heterogeneity across studies, much of this is explained by identifiable factors. Further standardisation of methodology for capturing resource utilisation data may further improve comparability of future studies. The cost estimates presented here may be of value for cost-of-illness studies and economic evaluations of novel diagnostic technologies and therapies for Alzheimer's disease.

BackgroundReliable data on costs of dementia care is critically important for estimating the value of novel therapies, technologies and methods in dementia care. The costs of dementia have been described in an increasing number of studies, however many are limited by small, selected samples and incomplete scope of cost categories included. Comparison of results has been challenged by considerable methodological heterogeneity, however increasing standardization of how resource utilization is measured and valued is increasing opportunities for systematic compilation of results. In this study we summarize available evidence on the costs of dementia in Europe through meta‐analysis on individual cost items.MethodWe conducted a systematic literature review to identify studies that collect and report costs of care in individuals with dementia. Costs were assessed in seven categories covering direct medical care (inpatient care, outpatient care, drugs), direct non‐medical care (institutional care, home care) and informal care (caregiver time loss, caregiver work loss). Data on study methodology, patient populations, care setting and disease severity was abstracted and harmonized across studies, and costs were converted to 2021 EUR.Result115 studies were included in the final review and meta‐analysis, reporting data for 631,281 patients from 17 countries. Annual total costs vary between regions within Europe, from approximately €6,000 EUR in Eastern Europe to €50,000 in Northern Europe, but consistently increase with disease severity and for institutionalized patients. Costs are dominated by informal care and non‐medical direct costs, while the balance of these two vary between regions. About half of the studies used a standardized scale for collecting resource utilization and cost data, the most common of which was the Resource Use in Dementia (RUD) instrument.ConclusionIn this study we construct the most comprehensive database to date of costs of dementia in relation to disease severity and care setting. Meta‐analytical estimates of care costs are possible but require categorization of resource use items and cross‐mapping of different measures of disease severity.