title: Preventing dementia by promoting physical activity and the long-term impact on health and social care expenditures.
abstract: BACKGROUND
  Preventing dementia has been proposed to increase population health as well as reduce the demand for health and social care. Our aim was to evaluate whether preventing dementia by promoting physical activity (PA) a) improves population health or b) reduces expenditure for both health and social care if one takes into account the additional demand in health and social care caused by increased life expectancy.
  
  
  METHODS
  A simulation model was developed that models the relation between PA, dementia, mortality, and the use of health care and social care in England. With this model, scenarios were evaluated in which different assumptions were made about the increase in PA level in (part of) the population.
  
  
  RESULTS
  Lifetime spending on health and social care related to dementia was highest for the physically inactive (£28,100/£28,900 for 40-year-old males/females), but spending on other diseases was highest for those that meet PA recommendations (£55,200/£43,300 for 40-year-old males/females) due to their longer life expectancies. If the English population aged 40-65 were to increase their PA by one level, life expectancy would increase by 0.23years and health and social care expenditures would decrease by £400 per person.
  
  
  CONCLUSIONS
  Preventing dementia by increasing PA increases life expectancy and can result in decreased spending overall on health and social care, even after additional spending during life years gained has been taken into account. If prevention is targeted at the physically inactive, savings in dementia-related costs outweigh the additional spending in life years gained.
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Electronic address: vanbaal@bmg.eur.nl.
authors.forename: Pieter H M van
authors.initials: PHMV
authors.lastname: Baal
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Electronic address: hoogendoorn@bmg.eur.nl.
authors.forename: Martine
authors.initials: M
authors.lastname: Hoogendoorn
authors.affiliation: Centre for Public Health, National Institute for Health and Care Excellence (NICE), 10 Spring Gardens, London SW1A 2BU, UK. Electronic address: Alastair.Fischer@nice.org.uk.
authors.forename: Alastair
authors.initials: A
authors.lastname: Fischer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003704:Dementia / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D004739:England / Q000453:epidemiology; D015444:Exercise / Q000502:physiology*; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D015995:Prevalence; D065840:Protective Factors; D012307:Risk Factors; D057185:Sedentary Behavior; D012947:Social Work / Q000191:economics* / Q000706:statistics & numerical data
keywords: Dementia; Health care; Physical activity; Prevention; Simulation modeling; Social care