Effectiveness of community non-pharmacological interventions for mild cognitive impairment and dementia: a systematic review of economic evaluations and a review of reviews

Background Dementia prevalence is increasing with no cure at present. Drug therapies have limited efficacy and potential side effects. People with dementia are often offered non-pharmacological interventions to improve quality of life and relieve symptoms. Identifying which interventions are cost-effective is important due to finite resources in healthcare services. Aims To review published economic evaluations of community non-pharmacological interventions for people with mild cognitive impairment or dementia and assess usefulness for decision making in health services. Methods Systematic review (PROSPERO CRD42021252999) included economic evaluations of non-pharmacological interventions for dementia or mild cognitive impairment with a narrative approach to data synthesis. Exclusions: interventions for dementia prevention/early detection or end of life care. Databases searched: Academic search premier, MEDLINE, Web of Science, EMBASE, Google Scholar, CINAHL, PsycInfo, Psychology and behavioural sciences collection, PsycArticles, Cochrane Database of Systematic Reviews, Business Source Premier and Regional Business News; timeframe 01 January 2011 to 30 June 2021 (13 September 2021 for Embase). Study quality assessed using CHEERS. Results Included thirty-two studies and five reviews, evaluating community dementia interventions worldwide across several distinct forms of care: physical activity, cognition, training, multi-disciplinary interventions and other (telecare/assistive technology, specialist dementia care, group living, home care versus care home). No single intervention was shown to be cost-effective across all economic evaluations. Conclusion More economic evidence on the cost-effectiveness of specific dementia care interventions is needed, with consistency around measurement of costs and outcomes data. Better information and higher-quality studies could improve decision makers confidence to promote future cost-effective dementia interventions.