RT Journal Article
SR Electronic
T1 The economic burden of dementia in low- and middle-income countries (LMICs): a systematic review
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e007409
DO 10.1136/bmjgh-2021-007409
VO 7
IS 4
A1 Siti Maisarah Mattap
A1 Devi Mohan
A1 Andrea Mary McGrattan
A1 Pascale Allotey
A1 Blossom CM Stephan
A1 Daniel D Reidpath
A1 Mario Siervo
A1 Louise Robinson
A1 Nathorn Chaiyakunapruk
YR 2022
UL http://gh.bmj.com/content/7/4/e007409.abstract
AB Introduction More than two-thirds of people with dementia live in low- and middle-income countries (LMICs), resulting in a significant economic burden in these settings. In this systematic review, we consolidate the existing evidence on the cost of dementia in LMICs.Methods Six databases were searched for original research reporting on the costs associated with all-cause dementia or its subtypes in LMICs. The national-level dementia costs inflated to 2019 were expressed as percentages of each country’s gross domestic product (GDP) and summarised as the total mean percentage of GDP. The risk of bias of studies was assessed using the Larg and Moss method.Results We identified 14 095 articles, of which 24 studies met the eligibility criteria. Most studies had a low risk of bias. Of the 138 LMICs, data were available from 122 countries. The total annual absolute per capita cost ranged from US$590.78 for mild dementia to US$25 510.66 for severe dementia. Costs increased with the severity of dementia and the number of comorbidities. The estimated annual total national costs of dementia ranged from US$1.04 million in Vanuatu to US$195 billion in China. The average total national expenditure on dementia estimated as a proportion of GDP in LMICs was 0.45%. Indirect costs, on average, accounted for 58% of the total cost of dementia, while direct costs contributed 42%. Lack of nationally representative samples, variation in cost components, and quantification of indirect cost were the major methodological challenges identified in the existing studies.Conclusion The estimated costs of dementia in LMICs are lower than in high-income countries. Indirect costs contribute the most to the LMIC cost. Early detection of dementia and management of comorbidities is essential for reducing costs. The current costs are likely to be an underestimation due to limited dementia costing studies conducted in LMICs, especially in countries defined as low- income.PROSPERO registration number The protocol was registered in the International Prospective Register of Systematic Reviews database with registration number CRD42020191321.Data are available on reasonable request.