Centre for the Economics of Mental Health, Institute of Psychiatry at King's College London, London, UK.
Int J Geriatr Psychiatry. 2013 Jun;28(6):551-61. doi: 10.1002/gps.3864. Epub 2012 Aug 12.
We reviewed evidence on the cost-effectiveness of prevention, care and treatment strategies in relation to dementia.
We performed a systematic review of available literature on economic evaluations of dementia care, searching key databases and websites in medicine, social care and economics. Literature reviews were privileged, and other study designs were included only to fill gaps in the evidence base. Narrative analysis was used to synthesise the results.
We identified 56 literature reviews and 29 single studies offering economic evidence on dementia care. There is more cost-effectiveness evidence on pharmacological therapies than other interventions. Acetylcholinesterase inhibitors for mild-to-moderate disease and memantine for moderate-to-severe disease were found to be cost-effective. Regarding non-pharmacological treatments, cognitive stimulation therapy, tailored activity programme and occupational therapy were found to be more cost-effective than usual care. There was some evidence to suggest that respite care in day settings and psychosocial interventions for carers could be cost-effective. Coordinated care management and personal budgets held by carers have also demonstrated cost-effectiveness in some studies.
Five barriers to achieving better value for money in dementia care were identified: the scarcity and low methodological quality of available studies, the difficulty of generalising from available evidence, the narrowness of cost measures, a reluctance to implement evidence and the poor coordination of health and social care provision and financing.
我们综述了与痴呆症相关的预防、护理和治疗策略的成本效益证据。
我们对痴呆症护理的经济评估相关的现有文献进行了系统综述，检索了医学、社会护理和经济学方面的主要数据库和网站。文献综述是首选的，其他研究设计仅被纳入以填补证据基础上的空白。采用叙述性分析对结果进行综合。
我们确定了 56 篇文献综述和 29 项关于痴呆症护理的经济证据的单项研究。在药物治疗方面，相对于其他干预措施，有更多的成本效益证据。对于轻度至中度疾病，乙酰胆碱酯酶抑制剂，对于中度至重度疾病，美金刚被认为是具有成本效益的。对于非药物治疗，认知刺激疗法、量身定制的活动计划和职业疗法被发现比常规护理更具成本效益。有一些证据表明，日间护理中的临时护理和对护理者的心理社会干预可能具有成本效益。在一些研究中，协调的护理管理和护理者持有的个人预算也被证明具有成本效益。
确定了实现痴呆症护理更好的性价比的五个障碍：现有研究的稀缺性和低方法质量、从现有证据推广的难度、成本衡量的狭隘性、对实施证据的不情愿以及卫生和社会保健提供和融资的协调不善。
