The economic burden of dementia in low- and middle-income countries (LMICs): a systematic review.
Siti Maisarah Mattap, Devi Mohan, Andrea Mary McGrattan, Pascale Allotey, Blossom Cm Stephan, Daniel D Reidpath, Mario Siervo, Louise Robinson, Nathorn Chaiyakunapruk
Author Information
Siti Maisarah Mattap: Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia. ORCID
Devi Mohan: Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia devi.mohan@monash.edu. ORCID
Andrea Mary McGrattan: School of Biomedical, Nutritional and Sports Sciences, Newcastle University, Newcastle upon Tyne, UK. ORCID
Pascale Allotey: Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia. ORCID
Blossom Cm Stephan: Institute of Mental Health, University of Nottingham, Nottingham, UK.
Daniel D Reidpath: International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
Mario Siervo: School of Life Sciences, University of Nottingham, Nottingham, UK.
Louise Robinson: Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Nathorn Chaiyakunapruk: Department of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, Utah, USA.
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.
