Reward doctors for early diagnosis of dementia, says think tank

BMJ 2012; 345 doi: (Published 17 December 2012) Cite this as: BMJ 2012;345:e8533
  1. Krishna Chinthapalli
  1. 1BMJ

Doctors and commissioners should be financially rewarded for diagnosing dementia, the economics think tank the Social Market Foundation has said.

Nigel Keohane, its deputy director and a coauthor of its report on dementia, said, “While there is no cure for dementia, early diagnosis means that patients can access treatment and support, allowing them and their families to prepare for the future progress of the condition. Costs to the state can be reduced if diagnosis happens earlier. That’s why incentives for GPs, clinical commissioning groups, and directors of public health should be directly linked to increased diagnosis rates and [why] practitioners should be free to innovate.”

The report, which was sponsored by the drug company Lilly UK, proposes that there should be a new Quality Outcomes Framework target for GPs to diagnose dementia, which would be linked to local prevalence estimates or to national commissioning targets.1 It also suggests targeted screening of groups of people at high risk of dementia, such as people with Parkinson’s disease, and the use of “social impact bonds.” These would be commissioned jointly by clinical commissioning groups and local authorities. They would require investors, such as drug companies, to provide funding for early diagnosis and management of dementia. In return the investors would receive a proportion of predicted future savings resulting from early diagnosis.

Sube Banerjee, dementia professor at Brighton and Sussex medical school and a member of the report’s steering group, explained that early diagnosis could reduce the healthcare burden. “Interventions at the time of early diagnosis, such as 4-5 sessions of carer training and support, can reduce care home use by a quarter. Simple changes at home, in care homes, and general hospitals can reduce the average length of hospital admissions, readmissions, and admissions to care homes,” he said at a press briefing to launch the report.

The authors say that dementia is a growing problem in the United Kingdom but that only 41% of cases are diagnosed. The cost of dementia to the UK in social care, healthcare, and unpaid carers is estimated at £23bn (€28bn; $37bn). In March 2012 the prime minister launched a national campaign on dementia, saying, “Dementia is one of the biggest challenges we face today—and it is one that we as a society simply cannot afford to ignore any longer.”2

However, James Cave, a GP and editor in chief of the Drugs and Therapeutics Bulletin, has raised concerns about the proposals. He told the BMJ, “The diagnosis of this condition, like many, has increasingly become a political football. Drug companies crave more diagnosis because it means more treatments, which increase their profits. Charities crave more diagnosis because it increases their fund base and increases their influence. I do not wish to understate dementia but try to suggest that a balance is needed.”

The report also notes that early diagnosis “allows access to drugs which can alleviate symptoms.” Eli Lilly previously promoted olanzapine for dementia3 and has completed phase III trials of a monoclonal antibody, solanezumab, to treat Alzheimer’s disease.


Cite this as: BMJ 2012;345:e8533