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First Global Dementia Legacy Event on Finance and
Social Impact Investment in Dementia
19 June 2014
Martin Knapp
Co-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 home
4. 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?
4150 4140 4300 4060 4200
9550 9160 9340 8480 9310
7470 7620 7530
8840
7850
0
5000
10000
15000
20000
25000
Current care (A) Donepezil (D1) Cognitive
stimulation (D2)
Case
management
(D3)
Carer support
(D4)
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
4150 4140 4300 4060 4200
9550 9160 9340 8480 9310
7470 7620 7530 8840 7850
0
2000
4000
6000
8000
10000
12000
Current care (A) Donepezil (D1) Cognitive
stimulation (D2)
Case
management
(D3)
Carer support
(D4)
Health care Social care Unpaid care
Improving dementia care: cost impacts
will not be evenly distributed
Some ‘improvements’ shift
more responsibility onto
family and other unpaid carers
Disease-modification: effects on costs
(£ millions, 2012 prices, UK)
What about the treatment costs?
Disease-modification: factoring in the
costs of the new treatments
Treatment 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)
m.knapp@lse.ac.uk

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Global Dementia Legacy Event: Professor Martin Knapp

  • 1. First Global Dementia Legacy Event on Finance and Social Impact Investment in Dementia 19 June 2014 Martin Knapp Co-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
  • 2. • 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?
  • 3. 1. Prevalent dementia population by age & gender Methods for our models 2. Severity of cognitive impairment 3. Place of residence: community or care home 4. Type of care (formal, unpaid, both, neither) 5. Cost & quality of life data from trials (n = 1400) 6. Estimate & compare scenario costs and QALYs
  • 4. The cost of dementia in England today – per person per year (£) (Scenario A) High costs; major impacts on quality of life
  • 5. • 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?
  • 6. 4150 4140 4300 4060 4200 9550 9160 9340 8480 9310 7470 7620 7530 8840 7850 0 5000 10000 15000 20000 25000 Current care (A) Donepezil (D1) Cognitive stimulation (D2) Case management (D3) Carer support (D4) 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
  • 7. 4150 4140 4300 4060 4200 9550 9160 9340 8480 9310 7470 7620 7530 8840 7850 0 2000 4000 6000 8000 10000 12000 Current care (A) Donepezil (D1) Cognitive stimulation (D2) Case management (D3) Carer support (D4) Health care Social care Unpaid care Improving dementia care: cost impacts will not be evenly distributed Some ‘improvements’ shift more responsibility onto family and other unpaid carers
  • 8. Disease-modification: effects on costs (£ millions, 2012 prices, UK) What about the treatment costs?
  • 9. Disease-modification: factoring in the costs of the new treatments Treatment costs will have a huge influence, depending on price and number treated These treatment costs are purely hypothetical
  • 10. 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
  • 11.
  • 12. • 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?
  • 13. Further details Thank you. Please collect a copy of our report here today. Also available on our website (www.pssru.ac.uk) m.knapp@lse.ac.uk