A systematic review of costs and benefits of population screening for dementia

• Published in: The Lancet (British edition) 2013-11, Vol.382 (S3), p.S56-S56
• Main Authors: Lafortune, Louise, Dr, Khan, Ayesha, PhD, Martin, Steven, MSc, Fox, Chris, MD, Cullum, Sarah, PhD, Dening, Tom, MD, Rait, Greta, PhD, Katona, Cornelius, MD, Brayne, Carol, MD
• Format: Article
• Language: English
• Subjects: Alzheimer disease; anxiety; cognition; Comparative studies; cost effectiveness; Dementia; Dementia disorders; Economics; elderly; Internal Medicine; issues and policy; learning; mental health; Older people; patients; people; planning; risk; screening; Systematic review; value added
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(13)62481-2

Abstract Background Despite over a decade of efforts to improve timely detection, as many as 50% of people with dementia do not receive a formal diagnosis or receive it too late to be clinically useful. Population screening (routine testing of a defined population even when no symptoms or signs have been reported) might provide part of the solution. However, the costs and benefits of this large-scale intervention are unclear. We undertook a systematic review of population screening to clarify the issue. We report on the evidence pertaining to clinical, psychosocial, and economic outcomes. Methods Eligible studies included those assessing population screening either as a standalone or component of a dementia intervention compared with a routine pattern of care in the general population or non-selected general practice or community care attendees. Non-comparative studies and models were also eligible. Relevant manuscripts published by May, 2012, for clinical and psychosocial outcomes (cognition, behaviours, physical and mental health, psychological and emotional wellbeing, stress, stigma, suffering, independence) and by April, 2013, for economic outcomes (cost, cost-effectiveness, cost benefit from any perspectives) were identified by unlimited searches tailored to outcome categories and databases (including Medline, Embase, CINAHL, DARE). Guided by the AMSTAR instrument, we used state-of-the-art methodology, including duplicate title scanning and extraction; no study was excluded on the basis of quality. Findings After screening 12 054 titles and examining the full text of 143 manuscripts, we found no studies that assessed the effect of screening on patient outcomes, such as cognitive, physical, mental or emotional health, social function, or planning. No studies were identified that assessed the potential harms caused by the screening results, such as risk of depression, anxiety, stigma, or loss of independence. For economic outcomes, we screened 5210 titles and examined the full text of 30 manuscripts. We identified three primary studies (one US study, mean age 74·6 years [SD 6·9] for positive screen and 71·1 years [5·5] for negative screen; two related Spanish studies, mean age 72·5 years [11·3]) reporting on the direct cost per patient diagnosed. Four modelling studies compared population screening scenarios with other models of dementia care—one model building on primary data (USA) and two on hypothetical cohorts (UK). Another model (USA) examined the