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)

m.knapp@lse.ac.uk