Dementia care costs and outcomes: a systematic review

Study Aim/Purpose: The purpose of this article was to review available literature evaluating the cost effectiveness of dementia care prevention, care and treatment strategies. 

Summary of Methods: The authors conducted an electronic search for published articles from 2005 and a web search of articles from 2000 onward evaluating interventions for people with dementia or their caregivers, which reported evidence on service use or costs, conducted in high income-countries. The databases searched included PubMed/Medline, Embase, PsychINFO, EconLit, The Cochrane Library, and the Center for Reviews and Dissemination. Additionally the following British Websites were searched: National Institute for Health and Clinical Evidence, the Social Care Institute for Excellence, the National Audit Office, the Royal College of Psychiatrists, the Royal college of General Practitioners, the Alzheimer’s Society, the King’s Fund, Carers UK, the Mental Health Foundation, Age U and the Bradford Dementia Group. The search included studies written in English, French, Italian and Spanish using a wide range of study designs (e.g., quantitative, qualitative, mixed-methods and economic evaluations). Meta-analysis was not performed because of the heterogeneity of the studies. Narrative analysis was used to synthesize results in four areas: 1) pharmacological interventions; (2) non-pharmacological interventions for individuals with dementia; (3) interventions for carers of individuals with dementia; and (4) organization of care and support. 

Summary of Key Results (related to studies of effectiveness): The search identified 56 literature reviews and 29 single studies that included pharmacological and nonpharmacological interventions for persons with dementia as well as respite and other supports for caregivers. With regard to studies on respite and supports for caregivers, the authors found some evidence of the cost effectiveness of respite care when provided in out-of-home day respite programs. However, no economic evidence was found for in-home respite, host family respite, institutional or overnight respite, or video respite. Several reviewed studies also indicate potential cost effectiveness of psychosocial interventions and training programs targeted to caregivers, with savings resulting from either significant delays in nursing home placements or reduced caregiving hours for the family caregiver. The authors indicate that there was also some evidence to suggest that coordinated care management and personal budgets for care provided to and controlled by caregivers could be cost-effective. 

Limitations of Studies Reviewed (as cited by the author): The authors note that the quality of the extant literature on economic evaluations of dementia care was low, and none of the findings in the literature reviews summarized were supported by meta-analysis because of the limited amount and heterogeneity of the available studies. For this same reason, the authors were unable to perform a meta-analysis on studies included in their review. 

Authors’ Discussion/Conclusions: With regard to recommendations for future research in this area, the authors recommend that studies examine cost savings and impacts beyond health costs to measure the economic impacts of dementia and dementia care more broadly including, for example, the opportunity costs of caregiver inputs and the impacts of caring on the health and well-being of caregivers.