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Effective interventions for potentially modifiable risk factors for late-onset dementia: a costs and cost-effectiveness modelling study
Open accessAbstract
Background The potential economic value of interventions to prevent late-onset dementia is unknown. We modelled this for potentially modifiable risk factors for dementia.Methods For this modelling study, we searched PubMed and Web of Science from inception to March 12, 2020, and included interventions that: successfully targeted any of nine prespecified potentially modifiable risk factors (hypertension, diabetes, hearing loss, obesity, physical inactivity, social isolation, depression, cigarette smoking, and less childhood education); had robust evidence that the intervention improved risk or risk behaviour; and are feasible to enact in an adult population. We established when in the life course each intervention would be delivered. We calculated dementia incidence reduction from annual incidence of dementia in people with each risk factor, and population attributable fraction for each risk, corrected for risk factor clustering, and how effectively the intervention controls the risk factor. We calculated the discounted value of lifetime health gain and effect on cost (including NHS, social care and carer costs) per person eligible for treatment. We estimated annual total expenditure on the fully operational intervention programme in England.Findings We found effective interventions for hypertension, smoking cessation, diabetes prevention, and hearing loss. Treatments for stopping smoking and provision of hearing aids reduced cost. Treatment of hypertension was cost-effective by reference to standard UK thresholds. The three interventions when fully implemented would save £1·863 billion annually in England, reduce dementia prevalence by 8·5%, and produce quality-adjusted life-year gains. The intervention for diabetes was unlikely to be cost-effective in terms of effect on dementia alone.Interpretation There is a strong case for implementing the three effective interventions on grounds of cost-effectiveness and quality-of-life gains, as well as for improvements in general health. The interventions have the potential to remain cost-saving or cost-effective even with variations in dementia incidence and costs and effectiveness of interventions.Funding Economic and Social Research Council.
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Interventions may be more likely in high-income countries as they depend on resource availability, despite potentially being cost-saving.
“Interventions may also be more likely in HICs as they depend on resource availability, despite potentially being cost-saving.(7) (8, 9)”
From Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (2024) · cites this paper as [7]
The Discussion (page not provided) says the interventions can remain cost-saving despite reduced effectiveness and notes that dementia reductions have occurred in higher socioeconomic groups. It does not say that resource availability makes these interventions more likely in high-income countries; it also suggests they might be especially useful in low- and middle-income countries. (LLM, conf=0.86)
Experimental — accuracy not yet measuredInterventions 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 [7]
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Self-citation
Metadata
- Authors
- Mukadam, N., Anderson, R., Knapp, M., Wittenberg, R., Karagiannidou, M., Costafreda, S. G., Tutton, M., Alessi, C., & Livingston, G.
- Affiliations
- University College London (GB)
- London School of Economics and Political Science (GB)
- Public Health England (GB)
- Corresponding author
- Mukadam, Naaheed
- ORCID
- Venue
- The Lancet Healthy Longevity
- Publisher
- Elsevier BV
- Published
- 2020-10
- Volume
- 1
- Issue
- 1
- Pages
- e13-e20
- ISSN
- 2666-7568 (ISSN-L)
- OpenAlex
- W3093704627
- Cited by
- 77
- References
- 28
- Citations by year
- 2026: 7 · 2025: 18 · 2024: 17 · 2023: 12 · 2022: 11 · 2021: 9 · 2020: 3
- FWCI
- 6.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Healthy Longevity (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Alzheimer's Society
- National Institute for Health and Care Research (10/43/01, ES/L001896/1)
- European Commission (HORIZON2020)
- University College London Hospitals NHS Foundation Trust
- School for Social Care Research
- Economic and Social Research Council (ES/L001896/1, ES/L001780/1)
- 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
- late-onset dementia, dementia prevention, modifiable risk factors, cost-effectiveness, hypertension, smoking cessation, diabetes prevention, hearing loss, hearing aids, population attributable fraction, quality-adjusted life years, social care costs
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