Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
BMJ Glob Health. 2022 Apr;7(4). doi: 10.1136/bmjgh-2021-007409.
More than two-thirds of people with dementia live in low- and middle-income countries (LMICs), resulting in a significant economic burden in these settings. In this systematic review, we consolidate the existing evidence on the cost of dementia in LMICs.
Six databases were searched for original research reporting on the costs associated with all-cause dementia or its subtypes in LMICs. The national-level dementia costs inflated to 2019 were expressed as percentages of each country's gross domestic product (GDP) and summarised as the total mean percentage of GDP. The risk of bias of studies was assessed using the Larg and Moss method.
We identified 14 095 articles, of which 24 studies met the eligibility criteria. Most studies had a low risk of bias. Of the 138 LMICs, data were available from 122 countries. The total annual absolute per capita cost ranged from US$590.78 for mild dementia to US$25 510.66 for severe dementia. Costs increased with the severity of dementia and the number of comorbidities. The estimated annual total national costs of dementia ranged from US$1.04 million in Vanuatu to US$195 billion in China. The average total national expenditure on dementia estimated as a proportion of GDP in LMICs was 0.45%. Indirect costs, on average, accounted for 58% of the total cost of dementia, while direct costs contributed 42%. Lack of nationally representative samples, variation in cost components, and quantification of indirect cost were the major methodological challenges identified in the existing studies.
The estimated costs of dementia in LMICs are lower than in high-income countries. Indirect costs contribute the most to the LMIC cost. Early detection of dementia and management of comorbidities is essential for reducing costs. The current costs are likely to be an underestimation due to limited dementia costing studies conducted in LMICs, especially in countries defined as low- income.
The protocol was registered in the International Prospective Register of Systematic Reviews database with registration number CRD42020191321.
超过三分之二的痴呆症患者生活在中低收入国家（LMICs），这给这些国家带来了巨大的经济负担。在这项系统综述中，我们整合了现有的关于 LMICs 中痴呆症成本的证据。
六个数据库被用来搜索关于所有原因导致的痴呆症或其在 LMICs 中的亚型的相关成本的原始研究报告。各国的痴呆症成本按 2019 年的通胀率计算，并以占国内生产总值（GDP）的百分比表示，并总结为 GDP 的总平均百分比。使用 Larg 和 Moss 方法评估研究的偏倚风险。
我们共识别了 14095 篇文章，其中 24 篇研究符合入选标准。大多数研究的偏倚风险较低。在 138 个 LMICs 中，有 122 个国家的数据可用。每年的人均绝对痴呆症成本从轻度痴呆症的 590.78 美元到重度痴呆症的 25510.66 美元不等。成本随着痴呆症的严重程度和合并症的数量而增加。估计的每年国家痴呆症总成本从瓦努阿图的 104 万美元到中国的 1950 亿美元不等。LMICs 中痴呆症的总国家支出占 GDP 的平均比例为 0.45%。间接成本平均占痴呆症总成本的 58%，而直接成本占 42%。在现有的研究中，主要的方法学挑战包括缺乏全国代表性样本、成本组成部分的变化以及间接成本的量化。
估计的 LMICs 中痴呆症的成本低于高收入国家。间接成本对 LMIC 成本的贡献最大。早期发现痴呆症和管理合并症对于降低成本至关重要。由于在 LMICs 中进行的痴呆症成本研究有限，尤其是在被定义为低收入的国家中，目前的成本可能被低估。
该方案在国际前瞻性系统评价数据库中进行了注册，注册编号为 CRD42020191321。
