Assessing the value of dementia risk reduction interventions. Mukadam N et al

The clinical and societal case for reducing dementia risk is increasingly well recognized and is a cornerstone of Think Brain Health and its recommendations. Limitations in healthcare resources mean that the value for money provided by implementing national health policies to reduce the clinical and economic burden of dementia needs to be assessed.

By using clinical and cost data from the UK, a newly published cost-effectiveness study showed interventions that seek to modify risk factors for late-onset dementia can both provide health benefits and reduce economic burden.¹ Specifically, implementing programmes to tackle hypertension, support smoking cessation and treat hearing loss could save around £1.86 billion per year in England and reduce the prevalence of dementia by 8.5%. Individually, treating hypertension would be cost-effective (i.e. a worthwhile investment) whereas reducing rates of smoking or hearing loss would lead to distinct cost savings. The major economic benefits are driven by savings associated with reduced needs for social and informal care.

The authors of the study, some of whom are members of the Lancet Commission on dementia prevention, intervention, and care, caution that the results are based on adhering to and meeting guideline targets. On the other hand, their analysis does not include additional benefits of interventions, such as reducing the burden of cardiovascular disease. Also, interventions for only four risk factors were evaluated due a lack of evidence for others (there are now 12 recognized modifiable risk factors for dementia). Therefore, the authors suggest that the results can be considered a conservative estimate of the benefits of investing more broadly in dementia risk-reduction programmes.

As noted in an accompanying editorial,² this important step forward in determining the benefits of dementia risk reduction programmes requires the ongoing generation of empirical evidence to produce increasingly robust predictions over time and in different healthcare settings.

¹Mukadam N et al. Effective interventions for potentially modifiable risk factors for late-onset dementia: a costs and cost-effectiveness modelling study. Lancet Healthy Longev. 2020;1:e13–e20
²Wimo A et al. The art of simulation. Lancet Healthy Longev. 2020;1:e2–e3