Challenges and recommendations for the health-economic evaluation of primary prevention programmes for dementia

Abstract

Objective: We aimed to review health-economic evaluations of (hypothetical) intervention programmes for the primary prevention of dementia, and highlight challenges and provide recommendations for future research to estimate its cost-effectiveness. Methods: We searched the databases PubMed, MODEM, CEA and NHS for publications on the cost-consequence, -effectiveness, -utility or -benefit analysis of (hypothetical) interventions to reduce the risk of developing dementia for persons without dementia, and described the study characteristics. Results: Three publications described the evaluation of a hypothetical risk reduction due to physical activity or a multidomain intervention programme. Two studies reported a reduction of care costs. One study yielded two scenarios of increased care costs and one scenario of reduced care costs. Only one study reported the impact in QALY terms, and found a QALY gain. Conclusion: A few studies have evaluated a hypothetical multidomain prevention intervention, and reported that primary dementia prevention is potentially cost-saving or cost-effective. Various challenges remain to evaluate the health-economic impact of prevention interventions, including extrapolation of short-term trial effects, care costs in the dementia-free and life years gained, and accurate representation of usual care. We recommend extensive sensitivity analyses to examine the impact of assumptions regarding these aspects on the outcomes of cost-effectiveness studies.

The art of simulation

“…6 So far, the question whether dementia prevention is cost-effective has not been supported by empirical evidence for several reasons. 7 The first issue is the discussion about causal links between results from observational studies on modifiable lifestyle and risk factors and long-term outcomes on dementia incidence and disability. The second issue is time.…”

“…In dementia, health economic models have been frequently used to evaluate pharmacological interventions, but rarely used for prevention. 7 Most economic evaluations have an empirical core from randomised clinical trials of intervention effects on clinically relevant outcomes, but this has not been the case so far for prevention of dementia.…”

Screening for Dementia Caused by Modifiable Lifestyle Choices Using Hybrid PET/MRI

“…Barnes et al [24] estimates seven risk factors contribute to half of Alzheimer's disease cases globally. Such risk factors can help identify those to be screened and since these risk factors, including physical inactivity, smoking and obesity, can be modified, early evidence of future dementia prior to cognitive decline could have an impact on patient motivation [43] that would delay onset [44,45]. Note that the prevalence in the population to be screened could be further increased by taking other risk factors into account such as genetic predisposition.…”

Cost of care for persons with dementia: using a discrete-time Markov chain approach with administrative and clinical data from the dementia service Centres in Austria

“…By stressing the three cost drivers—severity level, cost of informal care, and progression of dementia—the cost of ambulant dementia care could be estimated in order to provide a good basis for care provision planning [ 18 ]. Furthermore, the progressive nature of dementia has to be taken into consideration to estimate the prospective total cost of care [ 9 , 15 , 19 – 21 ].…”

“…In this study, we estimate the time a patient remains or deteriorates in their disease severity level over a discrete period of 1 year. The best approximation to cope with this problem seems to be the model of discrete time series with a discrete-time Markov chain (DTMC) [ 15 , 19 , 21 , 24 – 26 ]. For a health economic analysis, the combination of clinical assessment and administrative cost data from the DSCs brings new insights.…”