title: Dementia care costs and outcomes: a systematic review.
abstract: OBJECTIVE
  We reviewed evidence on the cost-effectiveness of prevention, care and treatment strategies in relation to dementia.
  
  
  METHODS
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for the Economics of Mental Health, Institute of Psychiatry at King's College London, London, UK. m.knapp@lse.ac.uk
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: Valentina
authors.initials: V
authors.lastname: Iemmi
authors.forename: Renee
authors.initials: R
authors.lastname: Romeo
mesh_terms: D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D003704:Dementia / Q000191:economics* / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D011314:Preventive Health Services / Q000191:economics