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The value of supportive care: A systematic review of cost-effectiveness of non-pharmacological interventions for dementia

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  • Angelica Guzzon
  • Vincenzo Rebba
  • Omar Paccagnella
  • Michela Rigon
  • Giovanni Boniolo

Abstract

Background: Almost 44 million people are currently living with dementia worldwide. This number is set to increase threefold by 2050, posing a serious threat to the sustainability of healthcare systems. Overuse of antipsychotic drugs for the management of the symptoms of dementia carries negative consequences for patients while also increasing the health expenditures for society. Supportive care (SC) interventions could be considered a safer and potentially cost-saving option. In this paper we provide a systematic review of the existing evidence regarding the cost-effectiveness and cost-utility of SC interventions targeted towards persons living with dementia and their caregivers. Methods: A systematic literature review was performed between February 2019 and December 2021 through searches of the databases PubMed (MEDLINE), Cochrane Library, CENTRAL, Embase and PsycINFO. The search strategy was based on PRISMA 2020 recommendations. We considered studies published through December 2021 with no lower date limit. We distinguished between five categories of SC strategies: cognitive therapies, physical activity, indirect strategies (organisational and environmental changes), interventions primarily targeted towards family caregivers, and multicomponent interventions. Results: Of the 5,479 articles retrieved, 39 met the inclusion criteria. These studies analysed 35 SC programmes located at different stages of the dementia care pathway. Eleven studies provided evidence of high cost-effectiveness for seven interventions: two multicomponent interventions; two indirect interventions; two interventions aimed at caregivers of community-dwelling persons with dementia; one community-based cognitive stimulation and occupational programme. Conclusion: We find that the most promising SC strategies in terms of cost-effectiveness are multicomponent interventions (targeted towards both nursing home residents and day-care service users), indirect strategies (group living and dementia care management at home), some forms of tailored occupational therapy, together with some psychosocial interventions for caregivers of community-dwelling persons with dementia. Our results suggest that the adoption of effective SC interventions may increase the economic sustainability of dementia care.

Suggested Citation

  • Angelica Guzzon & Vincenzo Rebba & Omar Paccagnella & Michela Rigon & Giovanni Boniolo, 2023. "The value of supportive care: A systematic review of cost-effectiveness of non-pharmacological interventions for dementia," PLOS ONE, Public Library of Science, vol. 18(5), pages 1-44, May.
    • Handle: RePEc:plo:pone00:0285305
    DOI: 10.1371/journal.pone.0285305
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    References listed on IDEAS

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    1. Björn Jobke & Thomas McBride & Linda Nevin & Larry Peiperl & Amy Ross & Clare Stone & Richard Turner & as the PLOS Medicine Editors, 2018. "Setbacks in Alzheimer research demand new strategies, not surrender," PLOS Medicine, Public Library of Science, vol. 15(2), pages 1-4, February.
    2. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884, Decembrie.
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