# Prevention of dementia using mobile phone applications (PRODEMOS) – a health-economic cost-utility analysis in people aged 55–75 years with low socio-economic status

## TL;DR

A mobile health app called PRODEMOS aimed at preventing dementia in older adults may not be cost-effective in the UK and China, based on assumptions about its long-term effectiveness.

## Contribution

The study evaluates the cost-effectiveness of a mobile health intervention for dementia prevention in low-SES populations in the UK and China.

## Key findings

- Simulations suggested dementia cases could be avoided in the UK and China, but results were uncertain due to assumptions.
- The intervention showed minimal gains in disease-free time for dementia-related outcomes.
- The incremental net health benefit was negative in both countries, indicating potential lack of cost-effectiveness.

## Abstract

•The PRODEMOS coach-supported mobile health intervention for the primary prevention of dementia, aimed at people aged 55 to 75 years with low SES in the UK and those of any SES in China, may potentially lack cost-effectiveness in both countries. However, the results were based on strong assumptions regarding causality and sustained effectiveness, which limits policy recommendations.

The PRODEMOS coach-supported mobile health intervention for the primary prevention of dementia, aimed at people aged 55 to 75 years with low SES in the UK and those of any SES in China, may potentially lack cost-effectiveness in both countries. However, the results were based on strong assumptions regarding causality and sustained effectiveness, which limits policy recommendations.

We aimed to explore the potential incremental cost-effectiveness of the PRODEMOS coach-supported mobile health intervention for primary prevention of dementia versus standard of care provided to people aged 55–75 years with low socio-economic status (SES) in the United Kingdom (UK), and any SES in China.

12–18-month PRODEMOS trial (ISRCTN15986016) efficacy outcomes on hypertension, obesity, hypercholesterolemia, physical inactivity and smoking were extrapolated to lifetime impact on dementia onset, myocardial infarction, stroke and death using a health-economic open-source simulation model.

Simulated outcomes showed dementia cases were avoided (UK = -206 (-658 to 281), China = -140 (-456 to 205) per 100,000 persons) and disease-free time was gained for dementia, myocardial infarction and stroke (mean months per person UK = 0.4, 0.0 and 0.0; China = 0.2, 0.0 and 0.0 respectively). Assuming a maximum intervention duration of 10 years with a 10 % annual non-adherence rate, the incremental net health benefit in the UK (-0.190) and China (-0.009) indicated a potential lack cost-effectiveness.

Our method was limited by strong assumptions regarding causality and sustained effectiveness, lack of some country-specific input estimates, and the lack of probabilistic analysis.

The PRODEMOS coach-supported mobile health intervention for the primary prevention of dementia, aimed at people aged 55 to 75 years with low SES in the UK and those of any SES in China, may potentially lack cost-effectiveness in both countries. However, lack of data required strong assumptions regarding causality and sustained effectiveness, which limited policy recommendations.