Global Dementia Legacy Event: Professor Martin Knapp

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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

Published in: Health & Medicine, Business
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Global Dementia Legacy Event: Professor Martin Knapp

  1. 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. 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. 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. 4. The cost of dementia in England today – per person per year (£) (Scenario A) High costs; major impacts on quality of life
  5. 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. 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. 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. 8. Disease-modification: effects on costs (£ millions, 2012 prices, UK) What about the treatment costs?
  9. 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. 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. 11. • 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?
  12. 12. 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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