Effectiveness of community non-pharmacological interventions for mild cognitive impairment and dementia: a systematic review of economic evaluations and a review of reviews

Background Dementia prevalence is increasing with no cure at present. Drug therapies have limited efficacy and potential side effects. People with dementia are often offered non-pharmacological interventions to improve quality of life and relieve symptoms. Identifying which interventions are cost-effective is important due to finite resources in healthcare services. Aims To review published economic evaluations of community non-pharmacological interventions for people with mild cognitive impairment or dementia and assess usefulness for decision making in health services. Methods Systematic review (PROSPERO CRD42021252999) included economic evaluations of non-pharmacological interventions for dementia or mild cognitive impairment with a narrative approach to data synthesis. Exclusions: interventions for dementia prevention/early detection or end of life care. Databases searched: Academic search premier, MEDLINE, Web of Science, EMBASE, Google Scholar, CINAHL, PsycInfo, Psychology and behavioural sciences collection, PsycArticles, Cochrane Database of Systematic Reviews, Business Source Premier and Regional Business News; timeframe 01 January 2011 to 30 June 2021 (13 September 2021 for Embase). Study quality assessed using CHEERS. Results Included thirty-two studies and five reviews, evaluating community dementia interventions worldwide across several distinct forms of care: physical activity, cognition, training, multi-disciplinary interventions and other (telecare/assistive technology, specialist dementia care, group living, home care versus care home). No single intervention was shown to be cost-effective across all economic evaluations. Conclusion More economic evidence on the cost-effectiveness of specific dementia care interventions is needed, with consistency around measurement of costs and outcomes data. Better information and higher-quality studies could improve decision makers’ confidence to promote future cost-effective dementia interventions. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was supported by the Institute for Lifecourse Development, and a Vice Chancellor's Scholarship from the University of Greenwich, in partnership with the NIHR Applied Research Collaboration Kent, Surrey & Sussex (ARC KSS). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present work are contained in the manuscript