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A systematic review of the cost-effectiveness of community and population interventions to reduce the modifiable risk factors for dementia
Open accessAbstract
Dementia is a leading global cause of morbidity and mortality. Evidence suggests that tackling modifiable lifecourse risk factors could prevent or delay a significant proportion of cases. Population- and community-based approaches change societal conditions such that everyone across a given community is more likely to live more healthily. We systematically reviewed economic studies of population- and community-based interventions to reduce modifiable lifecourse risk factors for dementia. We searched Medline, EMBASE, Web of Science, CINAHL, PsycInfo, Scopus, Econlit, ERIC, the British Education Index, and Google, on 03/03/2022. We included cost-effectiveness, cost-benefit, and cost-utility studies, provided that the direct outcome of the intervention was a modifiable risk factor for dementia, and was measured empirically. Quality appraisal was completed using the Consensus on Health Economic Criteria checklist. A narrative synthesis was performed. We included 45 studies, from 22,749 records identified. Included studies targeted smoking (n = 15), education (n = 10), physical inactivity (n = 9), obesity (n = 5), air pollution (n = 2), traumatic brain injury (n = 1), and multiple risk factors (n = 3). Intervention designs included changing the physical/food environment (n = 13), mass media programmes (n = 11), reducing financial barriers or increasing resources (n = 10), whole-community approaches (n = 6), and legislative change (n = 3). Overall, interventions were highly cost-effective and/or cost-saving, particularly those targeting smoking, educational attainment, and physical inactivity. Effects were observed in high- (e.g. USA and UK) and low- and middle-income (e.g. Mexico, Tanzania, Thailand) countries. Further research into the direct effects of targeting these risk factors on future dementia prevalence will have important economic, social and policy implications.
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Interventions for individual and multiple risks would potentially be cost-effective but scalability is challenging.
“Interventions for individual and multiple risks would potentially be cost-effective but scalability is challenging, (7, 277-279)”
From Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (2024) · cites this paper as [277]
The Summary of key findings (§4.1; page unavailable) says community- and population-based interventions were generally cost-effective or cost-saving. The Multiple risk factors section (§3.2.7; page unavailable) reports inexpensive reductions in two workplace studies, but largely null findings in a Swedish community study. The paper does not make a general claim that scalability is challenging; its Implications (§4.3) instead call for interventions to be replicated and upscaled. (LLM, conf=0.84)
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Dementia prevention, intervention, and care: 2020 report of the Lancet Commission
Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30367-6 · Cited by 10,430 · cited 5×
“Existing high-profile reviews of the effectiveness of dementia risk reduction interventions [3,59] focus almost entirely on individual-based approaches.”
InfluentialSelf-citationRetractedRayyan-a web and mobile app for systematic reviews.
Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016) · Systematic Reviews · doi:10.1186/s13643-016-0384-4 · Cited by 26,092
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Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission
Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., Ames, D., Banerjee, S., Burns, A., Brayne, C., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)01296-0 · Cited by 3,860
Self-citationPopulation-level interventions for the primary prevention of dementia: a complex evidence review
Walsh, S., Wallace, L., Kuhn, I., Mytton, O., Lafortune, L., Wills, W., Mukadam, N., & Brayne, C. (2024) · eClinicalMedicine · doi:10.1016/j.eclinm.2024.102538 · Cited by 43
Self-citationMukadam, N., Anderson, R., Walsh, S., Wittenberg, R., Knapp, M., Brayne, C., & Livingston, G. (2024) · The Lancet Healthy Longevity · doi:10.1016/s2666-7568(24)00117-x · Cited by 24
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Metadata
- Authors
- Walsh, S., Brain, J., Mukadam, N., Anderson, R., Greene, L., Govia, I., Kuhn, I., Anstey, K. J., Knapp, M., Stephan, B. C. M., & Brayne, C.
- Affiliations
- University of Nottingham (GB)
- University College London (GB)
- University of Oxford (GB)
- University of Exeter (GB)
- University of the West Indies (JM)
- University of Cambridge (GB)
- UNSW Sydney (AU)
- London School of Economics and Political Science (GB)
- Corresponding author
- Walsh, Sebastian
- ORCID
- Venue
- Maturitas
- Publisher
- Elsevier BV
- Published
- 2022-12
- Volume
- 166
- Pages
- 104-116
- ISSN
- 0378-5122 (ISSN-L)
- OpenAlex
- W4295654756
- Cited by
- 33
- References
- 3
- Citations by year
- 2026: 11 · 2025: 9 · 2024: 8 · 2023: 5
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Maturitas (publishedVersion, cc-by)
- PubMed (publishedVersion)
- London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (acceptedVersion)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Apollo (cc-by)
- Funders
- National Institute for Health and Care Research
- Alzheimer's Society
- NIHR Maudsley Biomedical Research Centre
- Australian Research Council (FL190100011)
- 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
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Keywords
- dementia prevention, modifiable risk factors, cost-effectiveness, community-based intervention, population-level interventions, smoking, educational attainment, physical inactivity, obesity, air pollution, traumatic brain injury, food environment, financial barriers, legislative amendment, health policy
- MeSH terms
- Cost-Benefit Analysis, Dementia, Health Promotion, Humans, Obesity, Risk Factors
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