Restricted accessReview articleFirst published online 2024-12
Economic evaluations of technology-based interventions used to provide care support for people with mild dementia or mild cognitive impairment and their caregivers: A systematic review
The cost-effectiveness of interventions is a key issue owing to the limited resources of healthcare services.
Objective
To conduct a systematic review of economic evaluations of technology-based healthcare interventions in care support for people with dementia or mild cognitive impairment (MCI) and their caregivers, and of the tools used to assess effectiveness and costs.
Methods
The following databases were used: PubMed, National Health Service Economic Evaluation Database, and Health Technology Assessment. A total of 207 articles from 2012 to 2024 were identified and then screened.
Results
Seventeen studies were included, of which nine were study protocols. Almost half (n = 8) the interventions were multicomponent. The most common components used in the interventions were cognitive stimulation, physical functioning and continuing support. Regarding the efficiency results of these interventions, only three studies provided a full economic evaluation. The most frequent tools in the economic evaluations used to measure effectiveness (measured in quality-adjusted life years) and costs were the European Quality of Life-5 Dimensions and Resource Utilization in Dementia instruments, respectively.
Conclusions
Most of the interventions evaluated were cost-effective. However, these results should be interpreted with caution, given the scarcity of the literature, and further economic evaluations of technology-based healthcare interventions for people with mild dementia or MCI care support and their caregivers are therefore needed. Additionally, a meta-analysis could not be performed due to the heterogeneity of the data.
GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health2022; 7: e105–e125.
2.
Global action plan on the public health response to dementia 2017–2025. Geneva: World Health Organization, 2017.
3.
Oliva-MorenoJPeña-LongobardoLMVilaplana-PrietoC. An estimation of the value of informal care provided to dependent people in Spain. Appl Health Econ Health Policy2015; 13: 223–231.
4.
WimoASeeherKCataldiR, et al.The worldwide costs of dementia in 2019. Alzheimers Dement2023; 19: 2865–2873.
FabbricottiINJanseBLoomanWM, et al.Integrated care for frail elderly compared to usual care: a study protocol of a quasi-experiment on the effects on the frail elderly, their caregivers, health professionals and health care costs. BMC Geriatr2013; 13: 31.
7.
Dixon-WoodsMKirkMDAgarwalMS, et al.Vulnerable groups and access to health care: a critical interpretive review. National Coordinating Centre NHS Service Delivery Organ RD (NCCSDO), 2005.
8.
RichELipsonDLiberskyJ, et al.Coordinating care for adults with complex care needs in the patient-centered medical home: challenges and solutions. In: White paper prepared by Mathematica Policy Research under Contract No. HHSA290200900019I/HHSA29032005T. AHRQ Publication No. 12–0010-EF. Rockville: Agency for Healthcare Research and Quality, 2012, pp.7–13.
9.
GomesMMurrayERafteryJ. Economic evaluation of digital health interventions: methodological issues and recommendations for practice. Pharmacoeconomics2022; 40: 367–378.
10.
LengMZhaoYXiaoH, et al.Internet-based supportive interventions for family caregivers of people with dementia: systematic review and meta-analysis. J Med Internet Res2020; 22: e19468.
11.
NickelFBarthJKolominsky-RabasPL. Health economic evaluations of non-pharmacological interventions for persons with dementia and their informal caregivers: a systematic review. BMC Geriatr2018; 18: 69.
12.
PournikOAhmadBLim Choi KeungSN, et al.CAREPATH: developing digital integrated care solutions for multimorbid patients with dementia. Stud Health Technol Inform2022; 295: 487–490.
13.
PournikOAhmadBLim Choi KeungSN, et al.Interoperable E-health system using structural and semantic interoperability approaches in CAREPATH. Stud Health Technol Inform2023; 305: 608–611.
14.
United Kingdom National Health Service Centre for Reviews and Dissemination. Systematic reviews: CRD’s guidance for undertaking reviews in health care. York: Centre for Reviews and Dissemination, University of York, 2009.
15.
GoereeRDiabyV. Introduction to health economics and decision-making: is economics relevant for the frontline clinician?Best Pract Res Clin Gastroenterol2013; 27: 831–844.
16.
DrummondMSculpherMClaxtonK, et al.Methods for the economic evaluation of health care programmes. 4th ed.United Kingdom: Oxford University Press, 2015.
17.
MoherDShamseerLClarkeM, et al.Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev2015; 4: 1.
18.
AngelesRCBergeLIGeddeMH, et al.Which factors increase informal care hours and societal costs among caregivers of people with dementia? A systematic review of Resource Utilization in Dementia (RUD). Health Econ Rev2021; 11: 37.
19.
ClarksonPDaviesLJasperR, et al.Home Support in Dementia (HoSt-D) Programme Management Group. A systematic review of the economic evidence for home support interventions in dementia. Value Health2017; 20: 1198–1209.
20.
Goodman-CasanovaJMGuzmán-ParraJGuerreroG, et al.TV-based assistive integrated service to support European adults living with mild dementia or mild cognitive impairment (TV-AssistDem): study protocol for a multicentre randomized controlled trial. BMC Geriatr2019; 19: 247.
21.
ShawCAWilliamsKNLeeRH, et al.Cost-effectiveness of a telehealth intervention for in-home dementia care support: findings from the FamTechCare clinical trial. Res Nurs Health2021; 44: 60–70.
22.
HuseboBSAlloreHAchterbergW, et al.LIVE@Home.Path-innovating the clinical pathway for home-dwelling people with dementia and their caregivers: study protocol for a mixed-method, stepped-wedge, randomized controlled trial. Trials2020; 21: 510.
23.
ReubenDBGillTMStevensA, et al.D-CARE: the Dementia Care Study: design of a pragmatic trial of the effectiveness and cost effectiveness of health system-based versus community-based dementia care versus usual dementia care. J Am Geriatr Soc2020; 68: 2492–2499.
24.
KleinOABoekholtMAfrinD, et al.Effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia: study protocol for a cluster randomised controlled trial (GAIN). Trials2021; 22: 401.
25.
Malmgren FängeASchmidtSMNilssonMH, et al.The TECH@HOME study, a technological intervention to reduce caregiver burden for informal caregivers of people with dementia: study protocol for a randomized controlled trial. Trials2017; 18: 63.
26.
van SantenJDröesRMBosmansJE, et al.The (cost-) effectiveness of exergaming in people living with dementia and their informal caregivers: protocol for a randomized controlled trial. BMC Geriatr2019; 19: 50.
27.
PonvelPShaharSSinghDKA, et al.Multidomain intervention for reversal of cognitive frailty, towards a personalized approach (AGELESS Trial): study design. J Alzheimers Dis2021; 82: 673–687.
28.
GhaniZSahaSJarlJ, et al.Short term economic evaluation of the digital platform “Support, Monitoring and Reminder Technology for Mild Dementia” (SMART4MD) for people with mild cognitive impairment and their informal caregivers. J Alzheimers Dis2022; 86: 1629–1641.
29.
BlomMMBosmansJECuijpersP, et al.Effectiveness and cost-effectiveness of an internet intervention for family caregivers of people with dementia: design of a randomized controlled trial. BMC Psychiatry2013; 13: 17.
30.
Piera-JiménezJDaugbjergSStafylasP, et al.Beyondsilos, a telehealth-enhanced integrated care model in the domiciliary setting for older patients: observational prospective cohort study for effectiveness and cost-effectiveness assessments. JMIR Med Inform2020; 8: e20938.
31.
Garzón-MaldonadoFJGutiérrez-BedmarMSerrano-CastroV, et al.An assessment of telephone assistance systems for caregivers of patients with Alzheimer’s disease. Neurologia2017; 32: 595–601.
32.
Guisado-FernandezEBlakeCMackeyL, et al.A smart health platform for measuring health and well-being improvement in people with dementia and their informal caregivers: usability study. JMIR aging2020; 3: e15600.
33.
StephenCSultanHFrewE. Valuing telecare using willingness to pay from the perspective of carers for people with dementia: a pilot study from the West Midlands. J Telemed Telecare2014; 20: 141–146.
34.
ChodoshJColaiacoBAConnorKI, et al.Dementia care management in an underserved community: the comparative effectiveness of two different approaches. J Aging Health2015; 27: 864–893.
35.
MilneHvan der PolMMcCloughanL, et al.The use of global positional satellite location in dementia: a feasibility study for a randomised controlled trial. BMC Psychiatry2014; 14: 160.
36.
WanYCaiYLiaoS, et al.Smartphone-based versus traditional face-to-face collaborative care for community-dwelling older adults living with dementia in China: protocol for an implementation science-based sequential multiple assignment randomised trial. BMJ Open2023; 13: e067406.
37.
MarshKPhillipsCJFordhamR, et al.Estimating cost-effectiveness in public health: a summary of modelling and valuation methods. Health Econ Rev2012; 2: 17.
38.
CaroJJBriggsAHSiebertU, et al.Modeling good research practices—overview. Med Decis Mak2012; 32: 667–677.
39.
PhilipsZBojkeLSculpherM, et al.Good practice guidelines for decision-analytic modelling in health technology assessment. Pharmacoeconomics2006; 24: 355–371.
40.
GuzzonARebbaVPaccagnellaO, et al.The value of supportive care: a systematic review of cost-effectiveness of non-pharmacological interventions for dementia. PLoS One2023; 18: e0285305.
41.
NguyenKHComansTAGreenC. Where are we at with model-based economic evaluations of interventions for dementia? A systematic review and quality assessment. Int Psychogeriatr2018; 30: 1593–1605.
42.
KnappMShehajXWongG. Digital interventions for people with dementia and carers: effective, cost-effective and equitable?Neurodegener Dis Manag2022; 12: 215–219.
43.
LiLNguyenK-HComansT, et al.Utility-based instruments for people with dementia: a systematic review and meta-regression analysis. Value Health2018; 21: 471–481.
44.
KeetharuthADHussainHRowenD, et al.Assessing the psychometric performance of EQ-5D-5L in dementia: a systematic review. Health Qual Life Outcomes2022; 20: 139.
45.
LloydHJenkinsonCHadiM, et al.Patient reports of the outcomes of treatment: a structured review of approaches. Health Qual Life Outcomes R2014; 12: 5.
46.
WolfJANiederhauserVMarshburnD, et al.Defining patient experience. Patient Exp J2014; 1: 7–19.
47.
World Health Organization. WHO global strategy on integrated people-centred health services 2016-2026: executive summary. Geneva, Switzerland: WHO, 2015.
48.
National Collaboration on Integrated Care and Support. Integrated care and support: our shared commitment. England, UK: NHS England, 2013.
49.
The King’s Fund. Implementing the NHS five year forward view: aligning policies with the plan. London, UK: NHS England, 2015.
50.
YangFDawesPLeroiI, et al.Measurement tools of resource use and quality of life in clinical trials for dementia or cognitive impairment interventions: a systematically conducted narrative review. Int J Geriatr Psychiatry2018; 33: e166–e176.
51.
SchulzKFAltmanDGMoherD, et al.CONSORT 2010 Statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med2010; 152: 726–732.
52.
von ElmEAltmanDGEggerM, et al.The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies [published correction appears in Ann Intern Med. 2008;148:168]. Ann Intern Med2008; 147: 573–577.
53.
HusereauDDrummondMAugustovskiF, et al.Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Value Health2022; 25: 3–9.
54.
TarriconeRTorbicaADrummondM. Challenges in the assessment of medical devices: the MedtecHTA Project. Health Econ2017; 26: 5–12.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
