A systematic review of the cost-effectiveness of community and population interventions to reduce the modifiable risk factors for dementia

Sebastian Walsh; Jacob Brain; Naaheed Mukadam; Robert Anderson; Leanne Greene; Ishtar Govia; Isla Kuhn; Kaarin J Anstey; Martin Knapp; Blossom C M Stephan; Carol Brayne

doi:10.1016/j.maturitas.2022.09.002

A systematic review of the cost-effectiveness of community and population interventions to reduce the modifiable risk factors for dementia

Maturitas. 2022 Dec:166:104-116. doi: 10.1016/j.maturitas.2022.09.002. Epub 2022 Sep 14.

Authors

Affiliations

¹ Cambridge Public Health, University of Public Health, Robinson Way, Cambridge CB2 0SR, United Kingdom of Great Britain and Northern Ireland. Electronic address: Sjw261@medschl.cam.ac.uk.
² Institute of Mental Health, Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham NG7 2TU, United Kingdom of Great Britain and Northern Ireland.
³ Division of Psychiatry, University College London, Maple House, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland.
⁴ Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, United Kingdom of Great Britain and Northern Ireland.
⁵ College of Medicine and Health, University of Exeter, Exeter EX1 2HZ, United Kingdom of Great Britain and Northern Ireland.
⁶ Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
⁷ University of Cambridge Medical School Library, School of Clinical Medicine, Cambridge CB2 0SP, United Kingdom of Great Britain and Northern Ireland.
⁸ UNSW Ageing Futures Institute, University of New South Wales, Kensington, Sydney 2033, Australia; Neuroscience Research Australia, 139 Barker Street, Randwick, NSW 2031, Australia.
⁹ London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom of Great Britain and Northern Ireland.
¹⁰ Cambridge Public Health, University of Public Health, Robinson Way, Cambridge CB2 0SR, United Kingdom of Great Britain and Northern Ireland.

PMID: 36150253
DOI: 10.1016/j.maturitas.2022.09.002

Abstract

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.

Keywords: Cost-effectiveness; Dementia; Population interventions; Prevention.

Publication types

Systematic Review
Review

MeSH terms

Cost-Benefit Analysis
Dementia* / prevention & control
Health Promotion
Humans
Obesity*
Risk Factors