A systematic review of the economic evidence for home support interventions in dementia

Objectives: Recent evidence signals the need for effective forms of home support to people with dementia and their carers. The cost-effectiveness evidence of different approaches to support is scant. This review aimed to appraise economic evidence on the cost-effectiveness of home support interventions for dementia to inform future evaluation.
Methods: A systematic literature review of full and partial economic evaluations was performed using the British National Health Service Economic Evaluation Database (NHS EED) supplemented by additional references. Study characteristics and findings, including Incremental Cost Effectiveness Ratios (ICERs), where available, were summarised narratively. Study quality was appraised using the NHS EED critical appraisal criteria and independent ratings, agreed by two reviewers. Studies were located on a permutation matrix describing their mix of incremental costs/effects to aid decision-making.
Results: Of 151 articles retrieved, 14 studies met the inclusion criteria: 8 concerning support to people with dementia and 6 to carers. Five studies were incremental Cost Utility Analyses, 7 cost-effectiveness analyses, and 2 cost consequences analyses. Five studies expressed ICERs as cost/QALY (£6,696 to £207,942/QALY). In 4 studies, interventions were dominant over usual care. Two interventions were more costly but more beneficial and were favourable against current acceptability thresholds.
Conclusions: Occupational therapy, home-based exercise, and a carers’ coping intervention emerged as cost-effective approaches for which there was better evidence. These interventions used environmental modifications, behaviour management, physical activity, and emotional support as active components. More robust evidence is needed to judge the value of these and other interventions across the dementia care pathway.