Cost-effectiveness of interventions for the treatment of dementia disorders

Abstract

By 2050, dementia is anticipated to cost $2 trillion per year globally. Strategic investment is required to mitigate the health and economic consequences of dementia. Projections suggest that, by the middle of the century, 68% of all cases of dementia worldwide will occur in low- and middleincome countries. Cost-effectiveness analysis of dementia requires more research to inform policy. To date, cost-effectiveness analysis has focused on pharmacological and nonpharmacological management. Whether pharmacological agents for dementias (e.g., acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists) are cost-effective is an area of ongoing contentious debate, but increasing evidence supports that they represent value for the money. An increasing number of on-pharmacological treatments are also considered cost-effective in certain circumstances (e.g., cognitive stimulation therapy, tailored activity programs, gingko biloba in occupational therapy, reminiscence therapies, and interventions for agitation). The potential gains from treating dementia diminish as dementia progresses, and measuring individuals' outcomes becomes increasing difficult as symptoms worsen. Current evidence suggests that a focus on the relative value of prevention strategies is required, as averting dementias would avoid significant suffering and may offset substantial costs, thus justifying larger investments. As dementia progresses over a number of years and through a number of stages, cost-effectiveness analysis based on primary data sources presents methodological issues; however, increased scientific attention is required to improve the methods and the evidence base to inform better decision-making on dementia.