Reducing dementia's impact on health and social care through early diagnosis and treatment

A series of reports commissioned by Alzheimer’s Society from Carnall Farrar have set out the economic and healthcare impacts of dementia. The first module from this programme of work highlighted the annual costs of dementia in the UK, which stand at £42 billion today, rising to £90 billion by 2040.  

Dementia has a major impact on the NHS

The latest modules from this research investigate the impact of dementia on the health system, and the role that early diagnosis and symptomatic treatment play in reducing system pressures and reducing the likelihood of crisis for people living with dementia.  

Suboptimal diagnosis, treatment, care and support results in a worse experience for individuals and means that dementia has a disproportionate impact on the healthcare system, with its impact set to increase significantly as prevalence grows.

People with dementia visit the GP up to three times more each year than someone without dementia of the same age. 

The growth in dementia means that, by 2040, there will 6.9 million additional primary care contacts associated with dementia, requiring an estimated 1.7 million more hours of primary care time.  

People with undiagnosed dementia attend A&E on average 1.5 times per year, which is higher than attendances for diagnosed mild, moderate, and severe dementia patients, and three times higher than attendances for patients without dementia.  

Early dementia diagnosis essential

Early diagnosis, treatment and support is essential to help people with dementia navigate the health system better. However, spending on diagnosis and treatment is equivalent to just 1.4% of total dementia healthcare costs. By contrast, unplanned hospital admissions make up almost a third of all dementia healthcare costs.  

There are interventions that can keep people well for longer and in their own homes.  

Existing symptomatic treatments have been found to improve cognition and quality of life and can reduce unplanned hospitalisation and premature admission to residential care. Our report has reviewed evidence around these benefits and modelled how early diagnosis and treatment interventions can be cost-effective.  

Right now, effective interventions are under-utilised, resulting in worse outcomes for people with dementia and greater costs for the health and care systems. Acetylcholinesterase (AChE) inhibitors are an example of one of these interventions: they are used to slow cognitive decline for people with Alzheimer’s disease and Lewy Body dementia.  

Though AChE inhibitors are not effective for everybody, this research has modelled how, for individuals where they are effective, early diagnosis and treatment with these medications has the potential to create cost savings of up to £9,000 - £45,000 per person by delaying admission to care homes.

While evidence around AChE inhibitors is mixed and there is a clear need for greater research in this space. Existing evidence shows that treatment can delay nursing home admission, with one study estimating this delay could be as long as 21 months. 

We modelled the cost impact of a three to 12 month delay resulting in a range of cost savings from £9,000 to £45,000.   

How does dementia affect the NHS?

Almost one in six hospital beds today are occupied by someone living with dementia, with the number of bed days for dementia patients expected to increase over time, growing from 20,500 beds in 2024 to 29,400 beds by 2040.

By 2040, 6.9 million additional primary care contacts, such as GP appointment, will be required each year, representing a 43% increase on current 2024 activity.  

Dementia patients are eight times more likely to use community-based services and 10 times more likely to use community mental health services.  

How can early dementia treatment help save costs?

NICE recommends cognitive stimulation therapy, AChE inhibitors and memantine as management options for people diagnosed with Alzheimer’s disease. Our research modelled the potential cost savings for a person with Alzheimer’s disease diagnosed early enough to take AChE inhibitors to delay symptom progression. Where these treatments are effective, delayed care home placement is estimated to result in per person savings of up to £9,000 - £45,000.

Cost savings from earlier diagnosis and treatment are expected to be distributed across both patient and the state, with people with dementia and their families each saving up to £10,000. 

Background to the reports

• The recent publications are for part of wider ongoing research at the Alzheimer’s Society on the economic impact of dementia with further reports yet to be published.
• This is one of the largest UK studies of healthcare resource utilisation by patients with dementia using a cohort of 26,097 dementia patients across Northwest London.
• The study used a combination of modelling, expert opinion and healthcare records to identify real per person healthcare costs incurred.
• Patient level data across primary and secondary care settings such as GP surgeries and hospitals, as well as mental health, and community and prescribing was used to identify real person healthcare costs.
• Costs associated with dementia beyond just health and social care such as quality of life and loss of economic consumption have been included.
• The report includes an estimation of healthcare costs of undiagnosed patients compared to diagnosed patients by analysing two years’ worth of healthcare costs pre-diagnosis. 

If you are involved in local or national decision-making and want to talk to us about dementia, please email: [email protected]