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Feature presentation - The economic case for action Professor Martin Knapp, Director, Health & Personal Social Services Research Unit, London School of Economics & Kings College London
Citation preview
First Global Dementia Legacy Event on Finance and Social Impact Investment in
Dementia
19 June 2014
Martin KnappCo-authors: Adelina Comas-Herrera, Raphael
Wittenberg, Bo Hu, Derek King, Amritpal Rehill and Bayo Adelaja
London School of Economics and Political Science
The Economic Case for Action
• Current care scenario: Care and support as currently provided in England (Scenario A).
• No-diagnosis scenario: Dementia is not diagnosed or treated (B).
• Diagnosis-only scenario: Dementia is diagnosed but not treated (C).
• Improved care scenario: Dementia is diagnosed, followed by evidence-based, ‘improved’ care and support (D).
• Disease-modifying scenario: Disease-modifying treatments are available to slow progression or delay (E).
What is the economic case for new dementia care scenarios?
1. Prevalent dementia population by age & gender
Methods for our models
2. Severity of cognitive impairment
3. Place of residence: community or care home4. Type of care (formal, unpaid, both, neither)5. Cost & quality of life data from trials (n = 1400)6. Estimate & compare scenario costs and QALYs
The cost of dementia in England today – per person per year (£)
(Scenario A)
High costs; major impacts on quality of life
• Current care scenario: Care and support as currently provided in England (Scenario A).
• No-diagnosis scenario: Dementia is not diagnosed or treated (B).
• Diagnosis-only scenario: Dementia is diagnosed but not treated (C).
• Improved care scenario: Dementia is diagnosed, followed by evidence-based, ‘improved’ care and support (D).
• Disease-modifying scenario: Disease-modifying treatments are available to slow progression or delay (E).
Is there an economic case for alternative dementia care
scenarios?
The two ‘worse’ scenarios – no diagnosis (B), no post-diagnostic support (C) – both increase costs and worsen quality of life
So what about the ‘better’ scenarios?
0
5000
10000
15000
20000
25000
4150 4140 4300 4060 4200
9550 9160 9340 8480 9310
7470 7620 75308840
7850
Unpaid care Social care Health care
Improving dementia care: modest effects on costs (£ millions, 2012
prices, UK)Quality of life improvements – important but not huge
0
2000
4000
6000
8000
10000
12000
4150 4140 4300 4060 42009550 9160 9340 8480 9310
7470 7620 7530 8840 7850
Health care Social care Unpaid care
Improving dementia care: cost impacts will not be evenly
distributedSome ‘improvements’ shift more responsibility onto family and other unpaid carers
Disease-modification: effects on costs
(£ millions, 2012 prices, UK)Highest cost …
but
also highest QALY
gain
What about the treatment costs?
Disease-modification: factoring in the costs of the new treatmentsTreatment costs will have a huge
influence, depending on price and number treated
These treatment costs are purely hypothetical
A completely different study from the LSE study: …• Research question: How could new
interventions change the trajectory of dementia in the UK to 2050?
• Method: Model combining ONS population/mortality projections to 2050, dementia prevalence by age/gender, costs of care.
• Base case: Without a disease-modifying treatment the numbers of people with dementia in UK will more than double by 2050 to reach 2 million.
OHE study for ARUK – Projecting future impacts of new dementia
interventions
• Dementia is already costly ... and much of that impact falls to family and other unpaid carers.
• Dementia will get much more costly… everywhere, soon.
• Currently known ‘improvements’ will help … to achieve quality of life gains, but costs will not fall much.
• Some of those economic gains rely heavily on carers … can they cope?
• Disease-modifying treatments are needed … to delay onset / slow progression … to cut costs and improve lives.
• We need a two-pronged approach … improve today’s care and find tomorrow’s cure (treatment breakthroughs).
What can we conclude?
Further details
Thank you.
Please collect a copy of our report here today. Also available on our
website (www.pssru.ac.uk)