Cost‐effectiveness of non‐pharmacological interventions for patients with dementia: A systematic review and meta‐analysis

Abstract

Background Non‐pharmacological interventions are widely used in the treatment of dementia, however, the cost‐effectiveness of them remains unclear. This study aimed to review and synthesize the economic evidence of non‐pharmacological interventions for patients with dementia (PwDs). Method Trial‐based studies evaluating both the costs and effects of non‐pharmaceutical interventions for PwDs were searched from PubMed, Web of Science, EconLit, NHS EED and other five relevant databases. Study quality was assessed using the Cochrane Risk of Bias Tool and the Consensus on Health Economic Criteria list. Cost data were standardized in 2020 US dollars and analyzed from the healthcare perspective. Random‐effects models were used to synthesize the incremental cost and effects of different interventions, based on mean differences (MDs) or standardized mean differences (SMDs). Result Thirty‐one eligible studies were identified from 40,587 records. The follow‐up periods ranged from post‐discharge to three years. Care coordination and case management programs brought significant savings of $314 (95%CI: $47 to $582) per person in total healthcare cost, alongside more quality‐adjusted life years (QALYs) gained for PwDs (SMD: 0.197; 95%CI: 0.050 to 0.344). Cognitive‐oriented therapy improved patients’ cognitive functions (SMD: 0.105; 95%CI: 0.006 to 0.204), whereas psychological intervention and behavioral management improved the neuropsychiatric symptoms (SMD: 0.109; 95%CI: 0.033 to 0.185). However, they were accompanied with significant increases in total healthcare cost, $490 (95%CI: $70 to $910) and $338 (95%CI: $238 to $438), respectively. Psychological intervention and behavioral management also deteriorated patients' activity functions (SMD: ‐0.195; 95%CI: ‐0.360, ‐0.030). Conclusion Care coordination and case management for PwDs are most likely to be cost‐effective with lower healthcare cost and better QALYs gained. The acceptance of cognitive‐oriented therapy, psychological intervention and behavioral management depends on the society’s willingness to pay for the improvements in patients’ health. More economic evidence is required on other types of interventions, such as physical exercise, occupational therapy, and day care program.

The economic case for scaling up health research and development: Lessons from the COVID-19 pandemic

“…Relatedly, our model could overstate spending in cases where scale-up of existing treatment options is a more cost-effective strategy. We note, however, the paucity of alternative treatments for ADRDs and the mixed evidence on their cost effectiveness ( 28 , 29 ). In the case of Strep A, if increased access to penicillin could more cheaply alleviate harm than developing vaccines, optimal R&D spending on vaccine development would be lower.…”

Economics and dementia: Challenges and responses

“…Despite the important roles of economic evidence, their use in decision-making remains limited. We outline below some examples to illustrate – as noted in several recent systematic reviews and meta-analyses (Huo et al, 2021a, 2021b, 2022; Walsh et al, 2022) – the current lack of economic evidence to support informed decisions.…”

“…Another reason could be that some non-pharmacological approaches are ‘complex interventions’ which tend to be intrinsically harder to evaluate. In a recent systematic review and meta-analysis, the authors noted that therapies targeting cognition, psychological intervention and behavioural management substantially increase costs, and their cost-effectiveness would depend largely on society’s willingness to pay (Huo et al, 2021a).…”

“…These findings differ from the conclusions of an earlier systematic review, which did not find convincing cost-effectiveness evidence (Pimouguet et al, 2010). In a more recent meta-analysis and systematic review, care coordination and case management programmes were found to be probably cost-effective, with savings in healthcare costs and QALY gains (Huo et al, 2021a).…”