Feature presentation - The economic case for action Professor Martin Knapp, Director, Health & Personal Social Services Research Unit, London School of Economics & Kings College London

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

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