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Dementia care costs and outcomes: a systematic review
Open accessAbstract
OBJECTIVE: We reviewed evidence on the cost-effectiveness of prevention, care and treatment strategies in relation to dementia. METHODS: We performed a systematic review of available literature on economic evaluations of dementia care, searching key databases and websites in medicine, social care and economics. Literature reviews were privileged, and other study designs were included only to fill gaps in the evidence base. Narrative analysis was used to synthesise the results. RESULTS: We identified 56 literature reviews and 29 single studies offering economic evidence on dementia care. There is more cost-effectiveness evidence on pharmacological therapies than other interventions. Acetylcholinesterase inhibitors for mild-to-moderate disease and memantine for moderate-to-severe disease were found to be cost-effective. Regarding non-pharmacological treatments, cognitive stimulation therapy, tailored activity programme and occupational therapy were found to be more cost-effective than usual care. There was some evidence to suggest that respite care in day settings and psychosocial interventions for carers could be cost-effective. Coordinated care management and personal budgets held by carers have also demonstrated cost-effectiveness in some studies. CONCLUSION: Five barriers to achieving better value for money in dementia care were identified: the scarcity and low methodological quality of available studies, the difficulty of generalising from available evidence, the narrowness of cost measures, a reluctance to implement evidence and the poor coordination of health and social care provision and financing.
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“Although UK policy recognises that psychological therapy for carers of family members with dementia should be a key component of high quality dementia care, in practice resources are not available, and this is partly because so far effective therapies have been delivered only by highly trained clinical psychologists and evidence on cost effectiveness is lacking.7”
From Clinical effectiveness of a manual based coping strategy programme (START, STrAtegies for RelaTives) in promoting the mental health of carers of family members with dementia: pragmatic randomised controlled trial (2013) · cites this paper as [7]
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“A recent review found some evidence that such interventions could lead to greater improvements in outcome and also generate cost savings.20”
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Metadata
- Authors
- Knapp, M., Iemmi, V., & Romeo, R.
- Affiliations
- King's College London (GB)
- Centre for the Economics of Mental Health Institute of Psychiatry at King's College London London UK
- Corresponding author
- Knapp, Martin
- Venue
- International Journal of Geriatric Psychiatry
- Publisher
- Wiley
- Published
- 2012-08-12
- Volume
- 28
- Issue
- 6
- Pages
- 551-561
- ISSN
- 0885-6230 (ISSN-L)
- 1099-1166
- OpenAlex
- W1940929028
- Cited by
- 126
- References
- 46
- Citations by year
- 2025: 4 · 2024: 3 · 2023: 5 · 2022: 11 · 2021: 6 · 2020: 7 · 2019: 11 · 2018: 16 · 2017: 10 · 2016: 16 · 2015: 15 · 2014: 13 · 2013: 9
- FWCI
- 1.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
- London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Alzheimer's Society
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- dementia care, cost-effectiveness, economic evaluation, acetylcholinesterase inhibitors, memantine, cognitive stimulation therapy, occupational therapy, respite care, personal budgets, implementation barriers, health and social care coordination
- MeSH terms
- Cost-Benefit Analysis, Delivery of Health Care, Dementia, Humans, Preventive Health Services, Health Care Costs
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