Assessing the cost-effectiveness of non-pharmacological therapies for dementia in the community

Background This thesis explores the cost-effectiveness of non-pharmacological therapies (NPTs) for people living with dementia (P LwD). NPTs aim to reduce symptoms and improve cognitive function or quality of life, alongside pharmacological therapies. However, their economic value remains unclear. Aims The thesis aimed to generate evidence to support decision-making around NPTs for PLwD and people with mild cognitive impairment (MCI). Specific objectives included: a) conducting a systematic review and review of reviews on the cost-effectiveness of NPTs; b) involving people with lived experience of dementia in prioritising the selection of community-based NPTs for further research; c) analysing mental health service use and costs pre- and post-diagnosis; and d) developing economic models to evaluate selected NPTs. Methods A systematic review of economic evaluations of community-based NPTs was conducted. A survey (n=50) involving caregivers, PLwD, and professionals identified priority interventions for further research. Two decision-tree models were developed to assess the cost-effectiveness of these interventions. A dataset of 16,081 patients was analysed to determine mental health service use and costs of these patients before and after a dementia diagnosis. Results The systematic review revealed limited economic evaluations of NPTs, despite growing interest. Survey participants prioritised music therapy (MT) and caregiver training programmes (CTP) for further research in this thesis. Economic modelling indicated that MT improved cognitive outcomes and reduced costs over six months, proving cost-effective. CTPs were cost-effective in the longer-term, to reduce behavioural symptoms in PLwD, and improve caregiver well-being, leading to being able to remain living at home for longer. Sensitivity analyses confirmed the robustness of findings. Analysis of mental health service use for PLwD showed higher costs and increased service use after diagnosis than before diagnosis. Conclusion This thesis provides new evidence supporting the cost-effectiveness of MT and CTPs for PLwD in UK community settings. While findings are promising, further research using robust epidemiological methods is needed to strengthen the evidence base.

Name dc:type.qualificationname

phd

Level dc:type.qualificationlevel

doctoral

Grantor dc:publisher.institution

University of Greenwich

Year dc:date.issued

2025

Author dc:creator

• Eaglestone, Gillian

Advisors dc:contributor.advisor

• Mccrone, Paul
• Pacella, Rosana
• Stoner, Charlotte R.

• RA Public aspects of medicine

Language dc:language

en