Mukadam Naaheed, Anderson Robert, Knapp Martin, Wittenberg Raphael, Karagiannidou Maria, Costafreda Sergi G, Tutton Madison, Alessi Charles, Livingston Gill
Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK.
Lancet Healthy Longev. 2020 Oct;1(1):e13-e20. doi: 10.1016/S2666-7568(20)30004-0.
The potential economic value of interventions to prevent late-onset dementia is unknown. We modelled this for potentially modifiable risk factors for dementia.
For this modelling study, we searched PubMed and Web of Science from inception to March 12, 2020, and included interventions that: successfully targeted any of nine prespecified potentially modifiable risk factors (hypertension, diabetes, hearing loss, obesity, physical inactivity, social isolation, depression, cigarette smoking, and less childhood education); had robust evidence that the intervention improved risk or risk behaviour; and are feasible to enact in an adult population. We established when in the life course each intervention would be delivered. We calculated dementia incidence reduction from annual incidence of dementia in people with each risk factor, and population attributable fraction for each risk, corrected for risk factor clustering, and how effectively the intervention controls the risk factor. We calculated the discounted value of lifetime health gain and effect on cost (including NHS, social care and carer costs) per person eligible for treatment. We estimated annual total expenditure on the fully operational intervention programme in England.
We found effective interventions for hypertension, smoking cessation, diabetes prevention, and hearing loss. Treatments for stopping smoking and provision of hearing aids reduced cost. Treatment of hypertension was cost-effective by reference to standard UK thresholds. The three interventions when fully implemented would save £1·863 billion annually in England, reduce dementia prevalence by 8·5%, and produce quality-adjusted life-year gains. The intervention for diabetes was unlikely to be cost-effective in terms of effect on dementia alone.
There is a strong case for implementing the three effective interventions on grounds of cost-effectiveness and quality-of-life gains, as well as for improvements in general health. The interventions have the potential to remain cost-saving or cost-effective even with variations in dementia incidence and costs and effectiveness of interventions.
Economic and Social Research Council.
预防迟发性痴呆的干预措施的潜在经济价值尚不清楚。我们针对痴呆症潜在的可改变风险因素进行了建模。
在这项建模研究中，我们检索了自数据库建立至2020年3月12日的PubMed和Web of Science数据库，纳入的干预措施需满足以下条件：成功针对九种预先指定的潜在可改变风险因素中的任何一种（高血压、糖尿病、听力损失、肥胖、身体活动不足、社交孤立、抑郁症、吸烟以及儿童期受教育程度较低）；有充分证据表明该干预措施改善了风险或风险行为；并且在成年人群中切实可行。我们确定了每种干预措施在生命历程中的实施时间。我们根据每种风险因素人群的痴呆症年发病率计算痴呆症发病率的降低情况，针对每种风险计算校正风险因素聚集后的人群归因分数，以及干预措施控制风险因素的有效性。我们计算了符合治疗条件的每人终身健康收益的贴现价值以及对成本（包括国民保健制度、社会护理和护理人员成本）的影响。我们估计了英格兰全面实施干预计划的年度总支出。
我们发现了针对高血压、戒烟、糖尿病预防和听力损失的有效干预措施。戒烟治疗和提供助听器可降低成本。参照英国标准阈值，高血压治疗具有成本效益。这三种干预措施全面实施后，每年将在英格兰节省18.63亿英镑，降低痴呆症患病率8.5%，并带来质量调整生命年收益。仅就对痴呆症的影响而言，糖尿病干预措施不太可能具有成本效益。
基于成本效益、生活质量提升以及对总体健康的改善，有充分理由实施这三种有效干预措施。即使痴呆症发病率、干预措施的成本和效果存在差异，这些干预措施仍有可能保持节省成本或具有成本效益。
经济和社会研究委员会。
