Abstract

Objectives: It is crucial to continue to advance what we know about the budgetary and economic implications of investing in new forms of effective action against dementia. Therefore, as part of the MODEM project we sought to identify the current state of the art in the economic analysis of actions to address dementia.

Methods: A systematic review protocol was developed to identify economic evaluations of interventions to address dementia and mild cognitive impairment published between 2009 and 2017. Protocol papers were also examined to see the potential direction of future economic analyses. The PubMed/Medline, Psychinfo, CINAHL, Econlit and Social Care Institute of Excellence databases were searched, along with a limited search of Google Scholar. There were no restrictions on the type of interventions other than exclusion of interventions focused on risk reduction in the general population. Interventions targeted at carers were included. Initially all abstracts were screened independently by two reviewers. Full texts were again screened independently by two reviewers with a third reviewer to resolve disagreements. A systematic map was constructed to illustrate changes over time in the focus of economic evaluations on types of intervention, target populations, study perspectives (e.g. health and/or long term care systems, other public purse, families and wider society), geographical coverage and economic methods.

Results: 1,151 studies were identified, of which 217 met initial screening criteria. After reading full texts, 157 studies were included in the analysis. Less than 20% of these evaluated pharmaceutical interventions; very few pharmacoeconomic studies were published after 2013. In contrast, there was steady growth in the studies on carer physical and mental wellbeing interventions, and on new models of care in the community and hospital /residential care settings. The majority of studies still take the form of traditional cost effectiveness / cost utility analyses, and narrowly focus on impacts on health and long term care services. Protocol papers indicate that attention is turning to evaluation of new workforce and service configurations, the use of new forms of cognitive stimulation, as well as telecare, online and other technological interventions.

Conclusions: Despite the increased profile of dementia in international health policy and research, the use of economic analysis as part of the evaluation of interventions remains remarkably limited. Most studies now focus on non-pharmacological interventions, including new approaches to care management and supporting family carers. Protocols suggest that more on the economic case for technology should be available in the coming years. It remains of concern, however, that there are very few replication studies looking at cost effectiveness in different country contexts. This will be needed to help make the case for implementation. The absence of studies set in rapidly ageing low-income countries that make up the majority of the world’s population also needs to be addressed.