OBJECTIVES: Over the last decade research on non-pharmacological interventions for persons with dementia (PwD) has gained momentum. The aim of this systematic review was therefore to assess the economic evidence on non-pharmacological interventions directly targeted at PwD.

METHODS: A systematic literature search was conducted in the following databases: Cochrane Library, Centre for Reviews and Dissemination, EconLit, Embase, PsycINFO and PubMed. Trial-based economic evaluations published between 2010 and 2016 were included. Study quality was assessed according to the Drummond checklist.

RESULTS: In total, nine RCT-based economic evaluations were identified. Of these, two studies evaluated exercise interventions for community-dwelling PwD. Considering the outcomes physical functioning and behavioral and psychological symptoms, these exercise programs were found likely to be cost-effective.

Another study indicated that individually tailored occupational therapy for PwD exhibiting behavioral and psychological symptoms is cost-effective.

Furthermore, the economic evidence on cognitive interventions was inconsistent. Joint reminiscence groups for community-dwelling PwD and informal caregivers as well as a carer-led individual cognitive stimulation therapy were unlikely to be cost-effective. In contrast, there is evidence that a group-based maintenance cognitive stimulation therapy for PwD residing in care homes or visiting day care centers is cost-effective.

With regard to psychological and behavioral treatments two interventions, namely self-management group rehabilitation for PwD and their spouses as well as cognitive-behavioral therapy for PwD-caregiver dyads, demonstrated effectiveness and cost-neutrality.

CONCLUSIONS: There is some evidence on cost-effective non-pharmacological interventions for PwD. However, the included studies showed a high degree of methodological heterogeneity with regard to outcomes, sample size, perspective and time horizon. In particular, quality-of-life values of PwD should be interpreted cautiously, this holds as well for proxy-rated values.

This research work was funded by the Karl and Veronica Carstens-Foundation as part of the national graduate college ‘Optimisation strategies in Dementia – OptiDem’.