A systematic review of the cost-effectiveness of community and population interventions to reduce the modifiable risk factors for dementia

Walsh, Sebastian; Brain, Jacob; Mukadam, Naaheed; Anderson, Robert; Greene, Leanne; Govia, Ishtar; Kuhn, Isla; Anstey, Kaarin J.; Knapp, Martin; Stephan, Blossom C. M.; Brayne, Carol

doi:10.1016/j.maturitas.2022.09.002

Cited by 11 publications

(13 citation statements)

References 51 publications

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“…Future studies should also investigate how modification of risk factors among individuals with a low SEP can be achieved cost-effectively and implemented at the population level. 44 …”

Section: Discussionmentioning

confidence: 99%

Role of cardiovascular health factors in mediating social inequalities in the incidence of dementia in the UK: two prospective, population-based cohort studies

van der Heide,

Valeri,

Dugravot

et al. 2024

eClinicalMedicine

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“…Future studies should also investigate how modification of risk factors among individuals with a low SEP can be achieved cost-effectively and implemented at the population level. 44 …”

Section: Discussionmentioning

confidence: 99%

Role of cardiovascular health factors in mediating social inequalities in the incidence of dementia in the UK: two prospective, population-based cohort studies

van der Heide,

Valeri,

Dugravot

et al. 2024

eClinicalMedicine

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“…Primary prevention approaches can utilise individualised, clinical approaches -which identify those at increased risk and support them to reduce risk; or population-level approaches -which change societal conditions to reduce risk exposure for the whole population. 5,6 Existing approaches to dementia risk reduction have heavily favoured individual-level approaches, 7 which typically widen inequalities and cannot significantly reduce disease prevalence. 5 The World Health Organization have recognised that redressing this imbalance is a public health research priority.…”

Section: Introductionmentioning

confidence: 99%

“…Primary prevention of dementia – action to reduce the risk factors – could therefore become an attractive option for policymakers. Primary prevention approaches can utilise individualised, clinical approaches – which identify those at increased risk and support them to reduce risk; or population‐level approaches – which change societal conditions to reduce risk exposure for the whole population 5,6 . Existing approaches to dementia risk reduction have heavily favoured individual‐level approaches, 7 which typically widen inequalities and cannot significantly reduce disease prevalence 5 .…”

Section: Introductionmentioning

confidence: 99%

Exploring English policymakers' attitudes towards dementia risk reduction: A qualitative study

Walsh,

Roscoe,

Mathie

et al. 2023

Int J Geriat Psychiatry

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AimA growing evidence‐base indicates that dementia occurrence can be changed. This has been linked to potentially modifiable risk factors. Risk reduction and primary prevention strategies are increasingly recognized as needing to include population‐level policies to tackle the social and commercial determinants of health. How this knowledge can influence policymaking on dementia prevention is unknown. Understanding attitudes of policymakers is an important step in translating evidence into practice, helping to gauge system readiness for implementation, and potential barriers and enablers for influencing policy. The aim of this qualitative study is to explore the understanding of, and attitudes to, dementia risk reduction and population‐level prevention strategies amongst English policymakers at national, regional, and local level.MethodsSemi‐structured interviews were undertaken with a range of dementia and prevention policymakers, with purposive sampling of national and local policymakers, including politicians, government officials, health system leaders, academics, and dementia charity directors. Analysis of interview transcripts was undertaken by thematic analysis.Results14 policymakers were interviewed between November 2021 and February 2022. Three main themes were identified (1) Preventability of dementia, (2) Prevention approach, (3) Barriers and facilitators to improving the approach.DiscussionPolicymakers generally held dementia to be partially preventable. Policymakers recognised that both individual‐ and population‐level approaches to primary prevention of dementia are required – with some policymakers perceiving that population‐level approaches are under‐utilised. Key barriers to implementing more population‐level approaches were identified as the complexity and co‐ordination required to effectively tackle upstream determinants of health.

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“…This definition means that people may have some substantial risk for developing dementia but are "clinically asymptomatic individuals with biological evidence of Alzheimer 's pathology" (Dubois et al, 2010: p. 5). So far, the health economic literature has focused solely on the risk-factors (21) or clinical disease stage (22)(23)(24). Thus, we identified a research gap in the literature of Cost-Effectiveness of primary prevention for people at the at-risk-state (25,26).…”

mentioning

confidence: 99%

“…For instance, the 'Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability' (FINGER)study, a randomized controlled trial based on multimodal nonpharmacological lifestyle interventions, showed effectiveness for preventing dementia due to multimodal interventions and alongside health economic studies on cost-effectiveness of prevention of dementia have been published and indicated a cost-saving potential for prevention strategies (7,(39)(40)(41). Walsh et al (2022) showed also with a high-quality systematic review of evidence, that the reduction of the defined risk factors by Livingston et al (2020) and the WHO (2019) is highly cost-effective and in some cases also cost-saving. But no health economic evidence-synthesis was conducted using a clearly defined 'people at risk' population.…”

mentioning

confidence: 99%

Cost-Effectiveness of Prevention for People at Risk for Dementia: A Scoping Review and Qualitative Synthesis

Braun,

Höfler,

Auer

2024

J Prev Alz Dis

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Dementia is from an economic perspective a main challenge for economies worldwide because of increasing costs. Since there is no cure in sight, prevention seems the most promising approach for reducing health care cost due to Dementia. On the contrary, approximately 40% of dementias is attributable to modifiable risk factors and first studies showed that multidomain interventions may be effective for preventing dementia. Considering the increasing economic burden, for many health administrations worldwide, cost-effectiveness plays a mayor role. This scoping review wants to bring evidence to the question if prevention for people at risk may be costeffective. Therefore, the four databases Medline (via Pubmed), CINHAL (via EBSCO), Business Source Complete (via EBSCO), and the Health Economic Evaluation database (HEED) were used to conduct a scoping review using PICO and a systematic search string. 3,629 studies were identified and seven met all inclusion criteria. The included studies showed clear costeffectiveness for most multidomain interventions. The gained QALYs at mean were 0.08 (SD=0.08) and the intervention average costs 472.20 EUR per Person (SD=74.06 EUR). The Incremental Cost-Effectiveness Ratios varied between -80,427.97 and 104,189.82 EUR per QALY. The three core results are (i) prevention programs focusing on people at risk may be costeffective and cost-efficient, (ii) multimodal prevention reveal cost saving potential, when the people at risk are defined well, (iii prevention in middle-aged cohorts may be also cost-effective if life-style related risk factors are addressed.

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A systematic review of the cost-effectiveness of community and population interventions to reduce the modifiable risk factors for dementia

Cited by 11 publications

References 51 publications

Role of cardiovascular health factors in mediating social inequalities in the incidence of dementia in the UK: two prospective, population-based cohort studies

Role of cardiovascular health factors in mediating social inequalities in the incidence of dementia in the UK: two prospective, population-based cohort studies

Exploring English policymakers' attitudes towards dementia risk reduction: A qualitative study

Cost-Effectiveness of Prevention for People at Risk for Dementia: A Scoping Review and Qualitative Synthesis

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