The impact of hypertension prevention and modification on dementia burden: A systematic review of economic studies

AIM: Neurological disorders account for the largest proportion of disability-adjusted life years globally, with dementia being the third leading cause. Hypertension has been identified as a priority, targetable risk factor for dementia. This study aimed to systematically review economic studies that examine the impact of hypertension prevention and control on the costs and outcomes of dementia. METHODS: An electronic literature search was conducted using MEDLINE, EMBASE, Scopus, Web of Science, EconLit, and grey literature sources. The inclusion criteria were: 1) economic evaluation studies, including both full and partial evaluations; 2) a primary focus on dementia; and 3) evaluation of the impact of preventing or modifying hypertension on the burden of dementia. The quality of included studies was assessed using the Consensus on Health Economic Criteria (CHEC) list. RESULTS: Twelve studies were included in the final review. Four studies were full economic evaluations, while eight were partial evaluations, with one reporting costs and seven reporting the impact on dementia prevalence. Nine studies considered hypothetical reductions in hypertension rate, while three evaluated applied hypertension-related interventions. Hypertension modification was associated with higher life expectancy and a higher average age of dementia onset. Full economic evaluations of specific hypertension modification interventions found that these interventions dominated (i.e. had lower costs and higher quality-adjusted life-years (QALY)) the status quo scenario or had an acceptable incremental cost-effectiveness ratio (ICER). CONCLUSIONS: Hypertension modification has the potential to reduce the burden of dementia in a cost-effective way. However, further economic evaluations of applied interventions are needed to determine real-world feasibility and cost-effectiveness.