Systematic review of health economic models for assessment and diagnosis of dementia

INTRODUCTION

Timely diagnosis of dementia is a public health priority to enable risk modification and treatment access. This study systematically identifies and critically appraises health economic models of dementia assessment and diagnosis.

METHODS

Inclusion criteria were: any dementia stage; evaluated strategy(ies) for initial assessment/diagnosis of dementia; health economic evaluation using decision modeling. Ten databases were searched for 2000–2024. Philips checklist was applied for quality assessment. Narrative synthesis appraised methodological features and issued decision-making recommendations.

RESULTS

Thirty-two studies were included. Six evaluated cerebrospinal fluid (CSF); 11 neuroimaging including amyloid-targeting positron emission tomography; three blood-based biomarkers; two genetic testing; and 10 early assessment/diagnosis strategies. Methodological limitations included non-consideration of capacity constraints. Decision-making recommendations generally affirmed current clinical guidelines: for example, CSF to confirm Alzheimer's disease is cost-effective (incremental cost-effectiveness ratio of £10,150 per quality-adjusted life-year gained vs. no use).

DISCUSSION

Methodological appraisal and decision-making recommendations should assist model development and evidence-based dementia diagnosis.