Systematic review of health economic models for assessment and diagnosis of dementia
Kwon J., Schoutens L., Burden M., Colam C., Zhao S., Nezafat Maldonado B., Blundell E., Krywonos A., Jiang J., Karagiannidou M., Jindra C., Vaci N., Roberts N., Wittenberg R., Knapp M., Castro Sanchez AY., Roncancio‐Diaz E., Potashman M., Thompson R., Handels R., Wolstenholme J., Gray AM., Landeiro F.
AbstractINTRODUCTIONTimely 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.METHODSInclusion 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.RESULTSThirty‐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).DISCUSSIONMethodological appraisal and decision‐making recommendations should assist model development and evidence‐based dementia diagnosis.