Modelling the health, social care and macroeconomic impacts of dementia policies in the UK

Dementia currently affects approximately 944000 older people in the UK and this figure is expected to rise to 1.35m in 2040 (7). Moreover, the number of affected individuals in need of unpaid or formal care is expected to rise by 124% between 2020 and 2040 (7). In addition to these dire prospects, social care provision for people with dementia and their carers is currently inadequate and under-funded, and research has further highlighted a lack of evidence from economic evaluations to guide policymakers on adequate dementia-focussed resourcing of the UK health and social care sector (18). Current health-economic studies of dementia and social care strategies use economic methodologies which are not appropriate to guide social care policy: they scale individual costs, fail to capture labour productivity impacts and include intangible costs. However, economic methods exist, known as health-focussed CGE models, which have been shown in other disease contexts to address these shortcomings. Their detailed specifications of economic supply and demand, government budget restrictions and private sector behaviour is ideally suited to estimate labour productivity effects, government budget impacts and spill-overs between economic sectors, and to maintain a unique focus on pecuniary impacts. Since pecuniary impacts are the main focus of fiscal policy makers and HM Treasury s economic analysts, CGE modelling is not only highly suitable for estimating the potential macroeconomic, health and social care impacts of dementia, but also highly policy-relevant for both prioritizing and advocating purposes. We propose to combine this macroeconomic modelling approach with a state-of-the-art multi-state lifetable model of dementia and apply it to analyse a set of social care policies, developed and designed to alleviate the under-servicing of people living with dementia, and with the aim to select the best policies based on a holistic set of tangible pecuniary macroeconomic and population-wide clinical health indicators which extend beyond the scope of previous COI approaches, and with the overarching goal to guide the UK government and Treasury on how to optimally invest in future social care provision to the benefit of the dementia community. Specifically, we will estimate the broader impact of dementia illness on UK society including its impacts on health, social care, and macroeconomic indicators over the next 20 years, and use this as a backdrop to analyse and select an optimal set of social care policies in order to expand the provision of adult social care for people with dementia, and at the same time achieve the best possible configuration of health, social care, and economic outcomes. The model will be stratified across key demographic strata for dementia to enable additional assessments of distributional policy impacts, and also designed to estimate potential trade-offs between social care provision and informal care time losses by employed individuals. Our project will use patient and public involvement and engagement throughout to ensure, that the design of our models and social care policies, as well as our analyses and policy recommendations, are appropriate and relevant. Our results will be shared with members of the dementia community and UK Treasury.