Health economic evaluations of interventions for the diagnosis of Dementia and Cognitive Impairment from Primary Care: a systematic review

Abstract

AbstractBackgroundDementia is a leading global cause of morbidity and mortality. There is evidence that population and community‐based interventions on early diagnosis of Dementia and Cognitive Impairment represent around US$10,000 of net savings per person with dementia across the disease course. They also avoid early or unnecessary admission to a care home or hospital and allows patients and their families to receive timely practical information, advice, and support. Only through receiving a diagnosis can they get access to available drug and non‐drug therapies that may improve their cognition and enhance their quality of life. This study aim is to identify existing evidence concerning the cost of implementing interventions strategies for the early diagnosis of Dementia and Cognitive Impairment from primary Care.MethodsWe systematically reviewed economic studies of community‐based interventions for diagnosing Dementia and Cognitive impairment from primary care. Medline, EMBASE, Web of Science, CINAHL, PsycInfo, Scopus were searched on 05/09/2022. Cost‐effectiveness, cost‐benefit, and cost‐utility studies were included, provided that the direct outcome of the intervention was the diagnosis of Dementia or Cognitive Impairment and was measured empirically. Quality appraisal was completed using the Consensus on Health Economic Criteria checklist. A narrative synthesis was performed.ResultsWe included 45 studies, from 2,749 records offering economic evidence on dementia diagnosis. Most of the reviewed studies were cost‐effectiveness analysis (n = 15 34.4%) followed by cost‐utility analysis (n = 8 19.6%). Among 20,330 patients screened, 9555 scored positive for Dementia (47%), 33% had cognitive impairment (CI), and 20% were considered to have no cognitive deficit. The prevalence of dementia was 6.0% (95%CI: 4.8%‐7.3%) and the mean of interventions strategies cost was $120 (95%CI: $112‐$136) per patient screened for dementia and $3798 (95%CI: $3702‐$3823) per patient diagnosed with dementia. Only 19% of patients with confirmed dementia diagnosis had documentation of dementia in their medical record. Most studies (56.1%) didn’t meet the methodological requirements contained in the quality assessment framework.ConclusionsOverall, interventions were cost‐effective and/or cost‐saving. However, there is a scarcity and low methodological quality of existing studies and the generalization from the available evidence is difficult because of the narrowness of cost measures in the literature.