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 describe… Show more
“…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.…”
Section: The Art Of Simulationmentioning
confidence: 99%
“…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.…”
“…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.…”
Section: The Art Of Simulationmentioning
confidence: 99%
“…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.…”
“…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.…”
Section: Analysis Of Impact Of a Five-year Delay In Dementia Onsetmentioning
Significant advances in positron emission tomography (PET) and magnetic resonance imaging (MRI) brain imaging in the early detection of dementia indicate that hybrid PET/MRI would be an effective tool to screen for dementia in the population living with lifestyle risk factors. Here we investigate the associated costs and benefits along with the needed imaging infrastructure. A demographic analysis determined the prevalence of dementia and its incidence. The expected value of the screening program was calculated assuming a sensitivity and specificity of 0.9, a prevalence of 0.1, a QALY factor of 0.348, a willingness to pay $114,000 CAD and the cost per PET/MRI scan of $2,000 CAD. It was assumed that each head PET/MRI could screen 3,000 individuals per year. The prevalence of dementia is increasing by almost two-fold every 20 years due to the increased population at ages where dementia is more prevalent. It has been shown that a five-year delay in the incidence of dementia would decrease the prevalence by some 45%. In Canada, a five-year delay corresponds to a health care savings of $27,000 CAD per subject per year. The expected value for screening was estimated at $23,745 CAD. The number of subjects to be screened per year in Canada, USA, and China between 60 and 79 was 11,405,000. The corresponding number of head-only hybrid PET/MRI systems needed is 3,800. A brain PET/MRI screening program is financially justifiable with respect to health care costs and justifies the continuing development of MRI compatible brain PET technology.
“…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 ].…”
Section: Introductionmentioning
confidence: 99%
“…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.…”
Background
There is growing evidence that the cost for dementia care will increase rapidly in the coming years. Therefore, the objective of this paper was to determine the economic impact of treating clients with dementia in outpatient Dementia Service Centres (DSCs) and simulate the cost progression with real clinical and cost data.
Methods
To estimate the cost for dementia care, real administrative and clinical data from 1341 clients of the DSCs were used to approximate the total cost of non-pharmaceutical treatment and simulate the cost progression with a discrete-time Markov chain (DTMC) model. The economic simulation model takes severity and progression of dementia into account to display the cost development over a period of up to ten years.
Results
Based on the administrative data, the total cost for treating these 1341 clients of the DSCs came to 67,294,910 EUR in the first year. From these costs, 74% occurred as indirect costs. Within a five-year period, these costs will increase by 7.1-fold (16.2-fold over 10 years). Further, the DTMC shows that the greatest share of the cost increase derives from the sharp increase of people with severe dementia and that the cost of severe dementia prevails the cost in later periods.
Conclusion
The DTMC model has shown that the cost increase of dementia care is mostly driven by the indirect cost and the increase of severity of dementia within any given year. The DTMC reveals also that the cost for mild dementia will decrease steadily over the time period of the simulation, whereas the cost for severe dementia increases sharply after running the simulation for 3 years.
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