Cost-Effectiveness of Nationwide Opportunistic Screening Program for Dementia in South Korea

Abstract

Although more demand for screening for dementia is envisaged, the cost-effectiveness of opportunistic population screening for dementia at a nationwide level has never been directly investigated. Since 2010, Korea has implemented "the National Dementia Early Detection Program" (NDEDP) for the aged. This study aims to investigate the cost-effectiveness of the NDEDP of Korea and to explore the requirements for enhancing its cost-effectiveness. A Markov model was developed to simulate the disease progression of dementia patients. Data sources for the model parameters included the NDEDP database for cohort characteristics and other national representative data. The model's estimates of the expected costs and Quality Adjusted Life Years (QALYs) for each strategy were used to calculate the incremental cost-effectiveness ratio of screening compared to no screening, and sensitivity analysis was performed to assess the effect of key variables on the cost-effectiveness. Screening showed that the cost per QALY gained ranged from $24,150 to $35,661 depending on the age group. The probability of screening being cost-effective was highest in the group over 75 years old in a wide range of willingness to pay (WTP). The implementation of an opportunistic screening program for dementia can be cost-effective depending on disease severity, treatment effect, costs by disease stage, ages of the participants, and the societal WTP. Above all things, improving access to more effective therapies in slowing the course of the disease is essential since the main benefit of earlier diagnosis for dementia is starting early treatment and subsequent savings. Although it is too early to conclude the cost-effectiveness of opportunistic population screening for dementia, this current study may be a meaningful step toward generating practical evidence for implementing an effective and efficient dementia screening program.

Where are we at with model-based economic evaluations of interventions for dementia? a systematic review and quality assessment

“…We identified 19 studies evaluating strategies for prevention (Zhang et al , 2011), early assessment (Getsios et al , 2012; Yu et al , 2015), screening (Retchin and Hillner, 1994; Djalalov et al , 2012), or diagnosis of dementia (14/19). Diagnosis studies covered a large variety of strategies, from imaging (magnetic resonance imaging, positron emission tomography, etc.)…”

“…This current literature indicates that it is a reasonable approach: a half of non-pharmacological studies sourced their models from pharmacological evaluations. For instance, a prevention strategy that reduced the dementia incidence rate (Zhang et al , 2011) or a more precise diagnosis method that led to a higher number of patients correctly diagnosed at early stage (Biasutti et al , 2012; Djalalov et al , 2012; Getsios et al , 2012; Yu et al , 2015) or a care program (for the dementia dyads) impacting on the disease progression (Martikainen et al , 2004; Dowd et al , 2018) can all share a disease progression model where subsequent costs and QALYs are accumulated and compared. This approach can potentially allow for the comparison of all interventions along the continuum of dementia care from prevention to active disease management.…”

“…None compared a pharmacological agent with a nonpharmacological intervention. Two studies (2/67) evaluated a hypothetical disease modification treatment for people with mild cognitive impairment and pre-dementia (Budd et al, 2011; Skoldunger et al, 2013), and three other studies evaluated non-pharmacological interventions: a family-based program for mild AD (Martikainen et al, 2004), deep brain stimulation for mild AD (Mirsaeedi-Farahani et al, 2015) and a connected health care program for mild dementia (Dowd et al, 2018).We identified 19 studies evaluating strategies for prevention(Zhang et al, 2011), early assessment(Getsios et al, 2012;Yu et al, 2015), screening(Djalalov et al, 2012;Retchin and Hillner, 1994) or diagnosis of dementia(14/19). Diagnosis studies covered a large variety of strategies, from imaging (magnetic resonance imaging, positron emission tomography, etc.…”

Which Stratum of Urban Elderly Is Most Vulnerable for Dementia?

“…In a Korean report analysing the cost-effectiveness of nationwide opportunistic screening program for dementia, the screening project of the Seoul Metropolitan Government did not lead to cost savings for the present (34). Among the several factors, screening all individuals over 65 years who want the test, not targeted to the patients with high risk, was thought to be the main factor.…”

Effects of a Dementia Screening Program on Healthcare Utilization in South Korea: A Difference-In-Difference Analysis

“…The purpose of this study was to evaluate the effect of the dementia screening program (DSP) conducted by the DSCs on healthcare service utilization. While there are debates about the pros and cons of screening for dementia, such as the risk of misdiagnosis, several studies on cost effectiveness have recently attempted to evaluate the outcomes of dementia screenings [20,21,22,23]. However, the effects of DSP analysis are based on a wide range of assumptions, and additional evidence on these healthcare service utilization topics is required.…”