Introduction
Dementia presents a significant global healthcare challenge, impacting millions and straining resources. By 2050, the number of individuals affected is projected to reach 139 million. The economic burden is substantial, with costs expected to triple by 2030. Despite available treatments, access barriers persist. Economic evaluations for dementia interventions play a crucial role in resource allocation decisions, offering insights into intervention effectiveness.
Twenty-three studies with the majority being cost-utility analyses were comprised within the scope of a review. The included studies, which were conducted from February 2018 to August 2022, underwent quality assessment using the Philips checklist and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. Various interventions were covered, including pharmacological, non-pharmacological, prevention, diagnostic, and integrated strategies. Markov transition models were commonly employed, with several interventions reported as cost-effective. However, the quality of reporting in the Methods and Results sections was suboptimal in most studies, highlighting areas for improvement in methodology and reporting standards.
Diversifying Intervention Approaches
While pharmacological treatments have been the focus, non-pharmacological strategies are also gaining recognition. However, research bias towards pharmacological interventions remains, highlighting the need for a balanced approach. Incorporating long-term outcomes and considering early-stage interventions are vital for comprehensive dementia management.
Global Disparities and Model Structures
Studies predominantly focus on high-income countries, indicating a need for broader geographical representation. Markov models are commonly used due to the chronic nature of dementia, with limited utilization of discrete-event simulation (DES) models. Transparent reporting of model assumptions and validation processes is essential for reliable results.
Addressing Methodological Gaps
Engaging stakeholders, including patients and caregivers, in model development enhances relevance and acceptance. While societal perspectives are crucial for comprehensive evaluations, their inclusion remains limited. Clear characterization of health states and consideration of multi-attribute measures are essential for accurate assessments.
Utility Measurement Challenges
Utility measurement methods lack detailed reporting, impacting the reliability of comparisons. The use of EQ-5D values is prevalent but may not capture the full spectrum of dementia-related health impacts. Incorporating condition-specific measures and distinguishing between self and proxy reports can enhance assessment accuracy.
Conclusions
This review provides valuable insights into model-based economic evaluations for dementia interventions, highlighting areas for improvement in methodology and reporting standards. By addressing existing gaps and methodological weaknesses, future studies can contribute significantly to optimizing dementia management strategies globally.
