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Cost-Effectiveness of Non-pharmacological Interventions for Mild Cognitive Impairment and Dementia: A Systematic Review of Economic Evaluations and a Review of Reviews

Author

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  • Gillian Eaglestone

    (University of Greenwich)

  • Evdoxia Gkaintatzi

    (University of Greenwich)

  • Harmony Jiang

    (University of Greenwich)

  • Charlotte Stoner

    (University of Greenwich)

  • Rosana Pacella

    (University of Greenwich)

  • Paul McCrone

    (University of Greenwich)

Abstract

Background Dementia prevalence is increasing, with no cure at present. Drug therapies have potential side effects and risk of mortality. People with dementia are frequently offered non-pharmacological interventions to improve quality of life and relieve symptoms. Identifying which interventions are cost-effective is important due to finite resources in healthcare services. Aims The aims were to review published economic evaluations of community and nursing home non-pharmacological interventions for people with mild cognitive impairment or dementia and assess the usefulness of these evaluations for decision making in health services, for use by policy and local and national decision makers. Methods We conducted a systematic review (PROSPERO CRD42021252999) of economic evaluations of non-pharmacological interventions for dementia or mild cognitive impairment with a narrative approach to data synthesis. Exclusions: interventions for dementia prevention/early detection/end of life care. Databases searched: Academic Search Premier, MEDLINE, Web of Science, EMBASE, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Psychology and Behavioural Sciences Collection, PsycArticles, Cochrane Database of Systematic Reviews, Business Source Premier and Regional Business News; timeframe 1 January 2011–11 May 2023. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Results The review included 37 economic evaluations and four reviews worldwide across several distinct forms of care: physical activity, cognition, training, multicomponent, assistive technology and other (specialist dementia care, group living, home care vs care home). The intervention with the strongest evidence of cost-effectiveness was maintenance cognitive stimulation therapy. Case management, occupational therapy and dementia care management also showed good evidence of cost-effectiveness. Conclusion More economic evidence on the cost-effectiveness of specific dementia care interventions is needed, with consistency of methods and outcome measures. This could improve local and national decision makers’ confidence to promote future cost-effective dementia interventions.

Suggested Citation

  • Gillian Eaglestone & Evdoxia Gkaintatzi & Harmony Jiang & Charlotte Stoner & Rosana Pacella & Paul McCrone, 2023. "Cost-Effectiveness of Non-pharmacological Interventions for Mild Cognitive Impairment and Dementia: A Systematic Review of Economic Evaluations and a Review of Reviews," PharmacoEconomics - Open, Springer, vol. 7(6), pages 887-914, November.
    • Handle: RePEc:spr:pharmo:v:7:y:2023:i:6:d:10.1007_s41669-023-00440-z
    DOI: 10.1007/s41669-023-00440-z
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    References listed on IDEAS

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    1. Qinglu Cheng & Nicholas Graves & Rosana E. Pacella, 2018. "Economic Evaluations of Guideline-Based Care for Chronic Wounds: a Systematic Review," Applied Health Economics and Health Policy, Springer, vol. 16(5), pages 633-651, October.
    2. Brown, Heather & D'Amico, Francesco & Knapp, Martin & Orrell, Martin & Rehill, Amritpal & Vale, Luke & Robinson, Louise, 2019. "A cost effectiveness analysis of maintenance cognitive stimulation therapy (MCST) for people with dementia: examining the influence of cognitive ability and living arrangements," LSE Research Online Documents on Economics 100841, London School of Economics and Political Science, LSE Library.
    3. Rose Sherri & van der Laan Mark J., 2009. "Why Match? Investigating Matched Case-Control Study Designs with Causal Effect Estimation," The International Journal of Biostatistics, De Gruyter, vol. 5(1), pages 1-26, January.
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