Thesis Format
Integrated Article
Degree
Master of Science
Program
Epidemiology and Biostatistics
Supervisor
Ali, Shehzad
2nd Supervisor
John-Baptiste, Ava
Co-Supervisor
Abstract
Modifying risk factors for dementia, such as hypertension, can significantly reduce the disease burden. Evidence on the economic value of diagnosing and controlling hypertension in relation to dementia has not been sufficiently investigated. The objectives of this thesis were to: 1) systematically review economic studies on the impact of hypertension modification on the dementia burden; 2) develop a lifetime economic model evaluating the cost-effectiveness of improved hypertension detection and management on the burden of dementia in Canada. The systematic review found that hypertension interventions were generally cost-effective; however, only two full economic evaluations were identified. The economic model found that hypertension diagnosis and control strategies were likely to be cost-effective from the perspective of dementia outcomes. Scenarios that improved hypertension control were significantly more cost-effective compared to the status quo. Future studies should evaluate the cost-effectiveness of real-world interventions to inform value-for-money for dementia investments.
Summary for Lay Audience
Dementia is characterized by the loss of memory, problem-solving, and other cognitive abilities. Due to the high economic costs associated with dementia care, and a lack of effective treatments, the prevention of dementia is a high priority. It is estimated that between 40-50% of dementia cases are due to 12 modifiable risk factors, one of which is high blood pressure, also known as hypertension. Improving hypertension awareness and blood pressure control can prevent dementia. Little is known about the cost-effectiveness of hypertension interventions for dementia prevention. The aim of this thesis was to review all economic studies that evaluate the impact of preventing or controlling hypertension and the subsequent impact on the economic burden of dementia. We will then create a novel economic model for assessing the impact of hypertension modification on dementia burden in Canada.
The review found 12 studies; three evaluated interventions that could be implemented such as better medication management, and nine evaluated the impacts of hypothetical reductions in the number of people with hypertension. Hypertension interventions were generally cost-effective. Studies that modeled reduced death rates due to the interventions found that dementia burden increased due to increased life expectancy, as people have more opportunity to develop dementia. Studies that did not consider changes in death rates found that hypertension reductions led to a decreased dementia burden. Future studies should evaluate the intervention effects’ using changes in costs and healthy life years, rather than only one, and evaluate specific and realistic interventions to maximize usefulness for decision-makers.
The economic evaluation tested the impact of interventions that: (1) diagnosed and controlled the blood pressure of everyone in the intervention; (2) diagnosed people but did not change the normal rates of uncontrolled hypertension (~40% of those who are diagnosed). We also tested each of these strategies one-time and yearly interventions.
The first type of intervention was significantly more cost-effective compared to the second type, when implemented once, and yearly. The results suggest that interventions that diagnose and control the blood pressure of everyone in the intervention are preferred to interventions that do not, from an economics perspective.
Recommended Citation
Lan, Marie, "The Cost-Effectiveness of Hypertension Modification Interventions to Reduce Dementia Burden" (2024). Electronic Thesis and Dissertation Repository. 10316.
https://ir.lib.uwo.ca/etd/10316
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License