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Aging Ment Health. 2017 Oct 17:1-7. doi: 10.1080/13607863.2017.1390730. [Epub ahead of print]

Challenges and recommendations for the health-economic evaluation of primary prevention programmes for dementia.

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a Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences , Maastricht University , Maastricht , The Netherlands.
b Department of Neurobiology, Care Science and Society, Division of Neurogeriatrics , Karolinska Institute , Stockholm , Sweden.
c Centre for Research & Development, Uppsala University / County Council of Gävleborg , Gävle , Sweden.



We aimed to review health-economic evaluations of (hypothetical) intervention programmes for the primary prevention of dementia, and highlight challenges and provide recommendations for future research to estimate its cost-effectiveness.


We searched the databases PubMed, MODEM, CEA and NHS for publications on the cost-consequence, -effectiveness, -utility or -benefit analysis of (hypothetical) interventions to reduce the risk of developing dementia for persons without dementia, and described the study characteristics.


Three publications described the evaluation of a hypothetical risk reduction due to physical activity or a multidomain intervention programme. Two studies reported a reduction of care costs. One study yielded two scenarios of increased care costs and one scenario of reduced care costs. Only one study reported the impact in QALY terms, and found a QALY gain.


A few studies have evaluated a hypothetical multidomain prevention intervention, and reported that primary dementia prevention is potentially cost-saving or cost-effective. Various challenges remain to evaluate the health-economic impact of prevention interventions, including extrapolation of short-term trial effects, care costs in the dementia-free and life years gained, and accurate representation of usual care. We recommend extensive sensitivity analyses to examine the impact of assumptions regarding these aspects on the outcomes of cost-effectiveness studies.


Costs; cognitive disorder; dementia; economic evaluation; multidomain lifestyle intervention; prevention

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