Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2018

Open Access 01-12-2018 | Research Article

Health economic evaluations of non-pharmacological interventions for persons with dementia and their informal caregivers: a systematic review

Authors: Franziska Nickel, Janina Barth, Peter L. Kolominsky-Rabas

Published in: BMC Geriatrics | Issue 1/2018

Login to get access

Abstract

Background

This systematic review aims to review the literature on trial-based economic evaluations of non-pharmacological interventions directly targeted at persons with dementia as well as persons with mild cognitive impairment and their respective caregivers.

Methods

A systematic literature research was conducted for the timeframe from 2010 to 2016 in the following databases: Centre for Reviews and Dissemination, EconLit, Embase, Cochrane Library, PsycINFO and PubMed. Study quality was assessed according to the Drummond criteria.

Results

In total sixteen publications were identified. Health economic evaluations indicated the cost-effectiveness of physical exercise interventions and occupational therapy. There was also evidence to suggest that psychological and behavioral therapies are cost-effective. Health economic studies investigating psychosocial interventions mainly targeted towards informal caregivers showed inconsistent results.

Conclusions

Due to the increasing prevalence of dementia non-pharmacological interventions and their health economic impact are of increasing importance for health care decision-makers and HTA agencies.
Appendix
Available only for authorised users
Literature
1.
Prince M, Wimo A, Guerchet M, Ali G-C, Wu Y-T, Prina M. World Alzheimer Report 2015: The global impact of dementia. An analysis of prevalence, incidence, cost and trends. London: Alzheimer's Disease International; 2015.
2.
Versijpt J. Effectiveness and cost-effectiveness of the pharmacological treatment of Alzheimer's disease and vascular dementia. J Alzheimers Dis. 2014;42(Suppl 3):S19–25.PubMed
3.
Ghezzi L, Scarpini E, Galimberti D. Disease-modifying drugs in Alzheimer’s disease. Drug Design, Development and Therapy. 2013;7:1471–9.PubMedPubMedCentral
4.
Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, Ballard C, Banerjee S, Burns A, Cohen-Mansfield J, et al. Dementia prevention, intervention, and care. Lancet (London, England). 2017;390(10113):2673–734.CrossRef
5.
Oyebode JR, Parveen S. Psychosocial interventions for people with dementia: an overview and commentary on recent developments. Dementia. 2016:1471301216656096.
6.
Moniz-Cook E, Vernooij-Dassen M, Woods B, Orrell M. Psychosocial interventions in dementia care research: the INTERDEM manifesto. Aging Ment Health. 2011;15(3):283–90.CrossRefPubMed
7.
Farina N, Rusted J, Tabet N. The effect of exercise interventions on cognitive outcome in Alzheimer's disease: a systematic review. Int Psychogeriatr. 2014;26(1):9–18.PubMed
8.
Groot C, Hooghiemstra AM, Raijmakers PG, van Berckel BN, Scheltens P, Scherder EJ, van der Flier WM, Ossenkoppele R. The effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trials. Ageing Res Rev. 2016;25:13–23.CrossRefPubMed
9.
Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S. Exercise programs for people with dementia. The Cochrane database of systematic reviews. 2015;4:Cd006489.
10.
Orgeta V, Qazi A, Spector AE, Orrell M. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. The Cochrane database of systematic reviews. 2014;1:Cd009125.
11.
Enache D, Winblad B, Aarsland D. Depression in dementia: epidemiology, mechanisms, and treatment. Current opinion in psychiatry. 2011;24(6):461–72.CrossRefPubMed
12.
Olazaran J, Reisberg B, Clare L, Cruz I, Pena-Casanova J, Del Ser T, Woods B, Beck C, Auer S, Lai C, et al. Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy. Dement Geriatr Cogn Disord. 2010;30(2):161–78.CrossRefPubMed
13.
Knapp M, Iemmi V, Romeo R. Dementia care costs and outcomes: a systematic review. Int J Geriatr Psychiatry. 2013;28(6):551–61.CrossRefPubMed
14.
Jones C, Edwards RT, Hounsome B. A systematic review of the cost-effectiveness of interventions for supporting informal caregivers of people with dementia residing in the community. Int Psychogeriatr. 2012;24(1):6–18.CrossRefPubMed
15.
Drummond MF, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddart GL. Methods for the Economic Evaluation of Health Care Programmes. Third Edition. London: Oxford University Press; 2005.
16.
Zweifel P, Breyer F, Kifmann M. Health Economics. 2nd ed. Berlin and Heidelberg: Springer-Verlag; 2009.
17.
Centre for Reviews and Dissemination: Systematic Reviews. CRD’s guidance for undertaking reviews in health care, University of York; 2009.
18.
Livingston G, Barber J, Rapaport P, Knapp M, Griffin M, King D, Romeo R, Livingston D, Mummery C, Walker Z, et al. Long-term clinical and cost-effectiveness of psychological intervention for family carers of people with dementia: a single-blind, randomised, controlled trial. The Lancet Psychiatry. 2014;1(7):539–48.CrossRefPubMed
19.
Livingston G, Barber J, Rapaport P, Knapp M, Griffin M, Romeo R, King D, Livingston D, Lewis-Holmes E, Mummery C, et al. START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia. Health technology assessment (Winchester, England). 2014;18(61):1–242.CrossRef
20.
Pitkälä KH, Poysti MM, Laakkonen ML, Tilvis RS, Savikko N, Kautiainen H, Strandberg TE. Effects of the Finnish Alzheimer disease exercise trial (FINALEX): a randomized controlled trial. JAMA Intern Med. 2013;173(10):894–901.CrossRefPubMed
21.
D'Amico F, Rehill A, Knapp M, Aguirre E, Donovan H, Hoare Z, Hoe J, Russell IS, A. Streater A, Whitaker C et al: Maintenance cognitive stimulation therapy: an economic evaluation within a randomized controlled trial. J Am Med Dir Assoc 2015, 16(1):63–70.
22.
Sogaard R, Sorensen J, Waldorff FB, Eckermann A, Buss DV, Phung KT, Waldemar G. Early psychosocial intervention in Alzheimer's disease: cost utility evaluation alongside the Danish Alzheimer's intervention study (DAISY). BMJ Open. 2014;4(1):e004105.CrossRefPubMedPubMedCentral
23.
Gitlin LN, Hodgson N, Jutkowitz E, Pizzi L. The cost-effectiveness of a nonpharmacologic intervention for individuals with dementia and family caregivers: the tailored activity program. Am J Geriatr Psychiatr. 2010;18(6):510–9.CrossRef
24.
Laakkonen ML, Kautiainen H, Holtta E, Savikko N, Tilvis RS, Strandberg TE, Pitkälä KH. Effects of self-management groups for people with dementia and their spouses-randomized controlled trial. J Am Geriatr Soc. 2016;64(4):752–60.CrossRefPubMed
25.
Spector A, Charlesworth G, King M, Lattimer M, Sadek S, Marston L, Rehill A, Hoe J, Qazi A, Knapp M, et al. Cognitive-behavioural therapy for anxiety in dementia: pilot randomised controlled trial. Br J Psychiatry. 2015;206(6):509–16.
26.
Woods RT, Bruce E, Edwards RT, Elvish R, Hoare Z, Hounsome B, Keady J, Moniz-Cook ED, Orgeta V, Orrell M, et al. REMCARE: Reminiscence groups for people with dementia and their family caregivers - Effectiveness and costeffectiveness pragmatic multicentre randomised trial. Health Technology Assessment. 2012;16(48):v–vii.CrossRefPubMed
27.
Orgeta V, Leung P, Yates L, Kang S, Hoare Z, Henderson C, Whitaker C, Burns A, Knapp M, Leroi I, et al. Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial. Health Technol Assess. 2015;19(64):7–73.CrossRef
28.
D'Amico F, Rehill A, Knapp M, Lowery D, Cerga-Pashoja A, Griffin M, Iliffe S, Warner J. Cost-effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM-E randomised controlled trial. International Journal of Geriatric Psychiatry. 2016;31(6):656–65.CrossRefPubMed
29.
Joling KJ, Bosmans JE, van Marwijk HWJ, van der Horst HE, Scheltens P, Vroomen JLM, van Hout HPJ. The cost-effectiveness of a family meetings intervention to prevent depression and anxiety in family caregivers of patients with dementia: A randomized trial. Trials. 2013;14(1) no pagination
30.
Dahlrup B, Nordell E, Steen Carlsson K, Elmstahl S. Health economic analysis on a psychosocial intervention for family caregivers of persons with dementia. Dement Geriatr Cogn Disord. 2013;37(3–4):181–95.PubMed
31.
Wray LO, Shulan MD, Toseland RW, Freeman KE, Vasquez BE, Gao J. The effect of telephone support groups on costs of care for veterans with dementia. The Gerontologist. 2010;50(5):623–31.CrossRefPubMed
32.
Van Houtven CH, Thorpe JM, Chestnutt D, Molloy M, Boling JC, Davis LL. Do nurse-led skill training interventions affect informal caregivers' out-of-pocket expenditures? The Gerontologist. 2013;53(1):60–70.CrossRefPubMed
33.
Davis JC, Bryan SM, Marra CA, Sharma D, Chan A, Beattie BL, Graf P, Liu-Ambrose T. An Economic Evaluation of Resistance Training and Aerobic Training versus Balance and Toning Exercises in Older Adults with Mild Cognitive Impairment. PLoS ONE. 2013;8(5) no pagination
34.
Prince M, Bryce R, Ferri C. World Alzheimer Report 2011: The benefits of early diagnosis and intervention. London: Alzheimer's Disease International; 2011.
35.
Lowery D, Cerga-Pashoja A, Iliffe S, Thuné-Boyle I, Griffin M, Lee J, Bailey A, Bhattacharya R, Warner J. The effect of exercise on behavioural and psychological symptoms of dementia: the EVIDEM-E randomised controlled clinical trial. International journal of geriatric psychiatry. 2014;29:819–27.CrossRefPubMed
36.
Orrell M, Aguirre E, Spector A, Hoare Z, Woods RT, Streater A, Donovan H, Hoe J, Knapp M, Whitaker C, et al. Maintenance cognitive stimulation therapy for dementia: single-blind, multicentre, pragmatic randomised controlled trial. Br J Psychiatr. 2014;204(6):454–61.
37.
Waldemar G, Waldorff FB, Buss DV, Eckermann A, Keiding N, Rishøj S, Siersma V, Sørensen J, Sørensen LV, Vogel A. The Danish Alzheimer intervention study: rationale, study design and baseline characteristics of the cohort. Neuroepidemiology. 2011;36(1):52–61.CrossRefPubMed
38.
Knapp M, King D, Romeo R, Schehl B, Barber J, Griffin M, Rapaport P, Livingston D, Mummery C, Walker Z, et al. Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial. BMJ (Clinical research ed). 2013;347:f6342.
39.
40.
Cummings J, Morstorf T, Lee G. Alzheimer's drug-development pipeline: 2016. Alzheimer's & Dementia: Translational Research & Clinical Interventions. 2016;2(4):222–32.
41.
Graff MJ, Adang EM, Vernooij-Dassen MJ, Dekker J, Jonsson L, Thijssen M, Hoefnagels WH, Rikkert MG. Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study. BMJ (Clin Res ed). 2008;336(7636):134–8.CrossRef
42.
Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B, Orrell M. Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis. The British journal of psychiatry : the journal of mental science. 2006;188:574–80.CrossRef
43.
Charlesworth G, Shepstone L, Wilson E, Thalanany M, Mugford M, Poland F: Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial. Health technology assessment (Winchester, England) 2008, 12(4):iii, v-ix, 1–78.
44.
Roberts J, Browne G, Milne C, Spooner L, Gafni A, Drummond-Young M, LeGris J, Watt S, LeClair K, Beaumont L, et al. Problem-solving counseling for caregivers of the cognitively impaired: effective for whom? Nurs Res. 1999;48(3):162–72.CrossRefPubMed
45.
Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, Omar RZ, Katona C, Cooper C. A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. Health technology assessment (Winchester, England). 2014;18(39):1–226. v-vi
46.
Davis JC, Bryan S, Marra CA, Hsiung G-YR, Liu-Ambrose T. Challenges with cost-utility analyses of behavioral interventions among older adults at risk for dementia. Br J Sports Med. 2015;49(20):1343–7.CrossRefPubMed
47.
Arons AM, Krabbe PF, Scholzel-Dorenbos CJ, van der Wilt GJ, Rikkert MG. Quality of life in dementia: a study on proxy bias. BMC Med Res Methodol. 2013;13:110.CrossRefPubMedPubMedCentral
48.
Aguirre E, Kang S, Hoare Z, Edwards RT, Orrell M. How does the EQ-5D perform when measuring quality of life in dementia against two other dementia-specific outcome measures? Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2016;25(1):45–9.CrossRef
49.
Orgeta V, Edwards RT, Hounsome B, Orrell M, Woods B. The use of the EQ-5D as a measure of health-related quality of life in people with dementia and their carers. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2015;24(2):315–24.CrossRef
50.
Algar K, Woods RT, Windle G. Measuring the quality of life and well-being of people with dementia: a review of observational measures. Dementia (London, England). 2016;15(4):832–57.
51.
Schaller S, Mauskopf J, Kriza C, Wahlster P, Kolominsky-Rabas PL. The main cost drivers in dementia: a systematic review. International Journal of Geriatric Psychiatry. 2015;30(2):111–29.CrossRefPubMed
52.
Wimo A, Jönsson L, Winblad B: Health economic aspects of dementia. In: Dementia, Fifth Edition. Edited by David Ames, Alistair Burns, O'Brien JT, vol. 5. Boca Raton: CRC Press; 2017.
53.
Krol M, Papenburg J, van Exel J. Does including informal care in economic evaluations matter? A systematic review of inclusion and impact of informal care in cost-effectiveness studies. PharmacoEconomics. 2015;33(2):123–35.CrossRefPubMed
54.
Shearer J, McCrone P, Romeo R. Economic evaluation of mental health interventions: a guide to costing approaches. PharmacoEconomics. 2016;34(7):651–64.CrossRefPubMed
55.
Dickinson C, Dow J, Gibson G, Hayes L, Robalino S, Robinson L. Psychosocial intervention for carers of people with dementia: what components are most effective and when? A systematic review of systematic reviews. Int Psychogeriatr. 2016;29(1):31–43.CrossRefPubMed
56.
Straubmeier M, Behrndt EM, Seidl H, Özbe D, Luttenberger K, Graessel E. Non-pharmacological treatment in people with cognitive impairment. Deutsches Arzteblatt international. 2017;114(48):815–21.
Metadata
Title
Health economic evaluations of non-pharmacological interventions for persons with dementia and their informal caregivers: a systematic review
Authors
Franziska Nickel
Janina Barth
Peter L. Kolominsky-Rabas
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2018
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-018-0751-1

Other articles of this Issue 1/2018

BMC Geriatrics 1/2018 Go to the issue

Research Article

Glial cell line-derived neurotrophic factor (GDNF) attenuates the peripheral neuromuscular dysfunction without inhibiting the activation of spinal microglia/monocyte

Research article

Use of over the counter products in older cardiovascular patients admitted to a tertiary care center in USA

Research article

Chronic morbidity and reported disability among older persons from the India Human Development Survey

Research article

Frail-VIG index: a concise frailty evaluation tool for rapid geriatric assessment

Research article

Risk factors for incident falls in older men and women: the English longitudinal study of ageing

Research article

Characteristics of elderly patients with polypharmacy who refuse to participate in an in-hospital deprescribing intervention: a retrospective cross-sectional study
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits