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Cost-Benefit Analysis of Dementia Interventions

Robert J Brent

Cost-Benefit Analysis (CBA) is the way to ascertain whether any kind of health care intervention is to be judged socially worthwhile. A worthwhile intervention is one where the benefits (the outcomes of everyone affected valued in monetary terms), exceeds the costs, also valued in monetary terms. Since the costs of interventions are reasonably well understood, the main challenge for CBA is to obtain a method for estimating the benefits that recognizes the reality of the scarcity of economic resources, yet also incorporates principles of fairness and justice. In this talk, a number of different benefit methods will be presented. Each method will be applied to a particular dementia intervention that has been evaluated using CBA. The expectation is that there will be at least one benefit method that someone would feel comfortable adopting for use in the CBA of any dementia intervention. There will be four main dementia CBAs presented: years of education, Medicare eligibility, hearing aids, and corrective lenses (glasses). All four dementia CBAs relied on a very large US panel data set provided by the National Alzheimer’s Coordination Center (NACC). The main strengths and weaknesses of the data will be explained. The instrument that is used to measure dementia in this data set is the Clinical Dementia Rating (CDR) scale, which covers six main domains: memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care. The advantages of using the CDR, which focuses on dementia symptoms (cognitive functioning) rather than dementia brain pathology (plaques, fibers, etc.) are then highlighted. The talk will conclude by showing how the four CBA interventions, that focus on dementia symptoms, are complementary with efforts in Europe and the US that seek to evaluate Dementia rehabilitation also on the basis of dementia behavior, especially TAP (the Tailored Activity Program).