The Costs of Dementia in Europe: An Updated Review and Meta-analysis

Abstract

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.

U.S. dementia care spending by state: 2010–2019

“…Wimo and colleagues found that informal care makes up 44% of total costs in high‐income countries and rises to 85% of the total cost for low‐income countries 25 . Even within Europe there is significant variation in the level of reliance on informal care, with informal care making up ≈75% of total cost in southern Europe and only 25% of total cost in the Nordic region 26 . These differences are likely due to a mix of cultural factors and variation in the amount and types of support policies in place for caregivers 27 …”

“…25 Even within Europe there is significant variation in the level of reliance on informal care, with informal care making up ≈75% of total cost in southern Europe and only 25% of total cost in the Nordic region. 26 These differences are likely due to a mix of cultural factors and variation in the amount and types of support policies in place for caregivers. 27 Our forecasts illustrate the impact of rising dementia prevalence, with total costs increasing by over 50% between 2019 and 2050, even if costs per prevalent case stay constant.…”

Predicting sojourn times across dementia disease stages, institutionalization, and mortality

“…While Memento and ADC obtained information from clinical follow‐up with patients and caregivers. We decided to create separate states for institutionalization given that the costs and mortality rates differ widely compared to those living in the community 17,18 …”

“…We decided to create separate states for institutionalization given that the costs and mortality rates differ widely compared to those living in the community. 17 , 18 …”

The affordability of lecanemab, an amyloid-targeting therapy for Alzheimer's disease: an EADC-EC viewpoint

“…The care structure for persons with dementia and the resource utilization and costs of dementia care differs substantially across Europe, both between and within countries and between majority and ethnic minority populations. 28 Simplifying, Northern European countries tend to have higher availability of formal care services such as home help and nursing homes, while in Southern Europe family caregivers provide most of the care. 29 Thus, the opportunity for offsetting high drug costs with lower costs for formal care differ substantially across countries, and the evidence for such offsets currently comes only from model projections.…”