Economic outcomes and levers: impacts for individuals and society

The pervasive scarcity of resources relative to the demands upon them makes it necessary for decision makers to think carefully about choices. Evidence from economics can help to inform such choices, particularly as it relates to costs, outcomes, the efficiency with which resources are used, the distribution of benefits and burdens across different individuals and budgets, and the processes by which care and treatment are delivered. However, there is still insufficient economic evidence to inform the full range of decisions to be taken in the dementia field; indeed the accumulated volume of evidence remains very modest. The measurement of cost is often too narrow, and there is some disagreement about whether and how to include the costs (direct or indirect) incurred by caregivers. The conceptualization of outcomes for certain purposes has generated argument, especially when attempts are made to introduce generic measures that apply across many clinical areas. It has not always been demonstrated that such measures have any validity in the dementia field. Other comparatively neglected areas have been research on equity and the processes by which care is delivered. Finally, the paper looks at economic barriers to implementation of evidence-based interventions, and the policy levers that might prove influential.