{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T18:23:23Z","timestamp":1777400603986,"version":"3.51.4"},"update-to":[{"DOI":"10.12688\/hrbopenres.14064.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000}},{"DOI":"10.12688\/hrbopenres.14064.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000}}],"reference-count":21,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015442","name":"Global Brain Health Institute","doi-asserted-by":"publisher","award":["212322"],"award-info":[{"award-number":["212322"]}],"id":[{"id":"10.13039\/100015442","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["hrbopenresearch.org"],"crossmark-restriction":false},"short-container-title":["HRB Open Res"],"abstract":"\n Introduction Dementia remains incurable, and treatment trials are typically conducted after the symptoms manifest, potentially too late in the disease process to alter its course. Thus, it is essential to identify and implement cost-effective strategies targeting individuals who have not yet been formally diagnosed with dementia. This review aims to scrutinise emerging evidence and present a comprehensive summary of cost-effectiveness estimates of all strategies targeting the pre-diagnosis dementia populations. Method and analysis A systematic search will be conducted across six electronic databases. All articles will be assessed against pre-defined eligibility criteria through title and abstract screening, and full-text screening phases. Data from the included articles will be extracted using a standardized template. A newly established framework based on the CHEERS 2022 checklist will be applied to assess the reporting quality of the included articles. The entire review process, from screening to data extraction and quality assessment, will be a dual process conducted by two reviewers. Disagreements will be resolved by a third senior reviewer. The extracted data will be synthesised and presented in tables and figures. Conclusion This systematic review will present evidence of cost-effectiveness, along with the strengths and limitations of the existing literature. These findings aim to identify existing gaps, thereby informing and guiding the design of future studies in this domain. Ethics and dissemination Since this is a systematic review protocol, ethical approval is not required. The results will be published in a peer-reviewed journal, with both raw and summarised data shared through the journal or other open platforms. Systematic review registration PROSPERO -\n CRD42024521521<\/ns3:ext-link>\n .\n <\/ns3:p>","DOI":"10.12688\/hrbopenres.14064.3","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T01:00:06Z","timestamp":1763686806000},"page":"11","update-policy":"https:\/\/doi.org\/10.12688\/hrbopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Economic evaluations \u00a0of strategies targeting pre-diagnosis dementia \u00a0populations: Protocol for a systematic review"],"prefix":"10.12688","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8187-8277","authenticated-orcid":false,"given":"Men Thi","family":"Hoang","sequence":"first","affiliation":[{"name":"Trinity College Institute of Neuroscience Dublin Leinster Trinity College Dublin"},{"name":"School of Medicine Dublin Leinster Trinity College Dublin"},{"name":"Faculty of Business Administration Ho Chi Minh City Van Lang University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8392-3028","authenticated-orcid":false,"given":"Alina","family":"Zenker","sequence":"additional","affiliation":[{"name":"Health Economics Unit, Department of Clinical Science (Malm\u00f6) Lund Lund University"},{"name":"School of Medicine Dublin Leinster Trinity College Dublin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8649-0773","authenticated-orcid":false,"given":"Sanjib","family":"Saha","sequence":"additional","affiliation":[{"name":"Health Economics Unit, Department of Clinical Science (Malm\u00f6) Lund Lund University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulf-G\u00f6ran","family":"Gerdtham","sequence":"additional","affiliation":[{"name":"Health Economics Unit, Department of Clinical Science (Malm\u00f6) Lund Lund University"},{"name":"Department of Economics Lund Lund University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1421-2966","authenticated-orcid":false,"given":"Dominic","family":"Trepel","sequence":"additional","affiliation":[{"name":"Trinity College Institute of Neuroscience Dublin Leinster Trinity College Dublin"},{"name":"School of Medicine Dublin Leinster Trinity College Dublin"},{"name":"Global Brain Health Institute Dublin Trinity College Dublin"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"ref-1","article-title":"Dementia.","year":"2025"},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"1752-63","DOI":"10.1002\/alz.12802","article-title":"Pre-diagnostic cognitive and functional impairment in multiple sporadic neurodegenerative diseases.","volume":"19","author":"N Swaddiwudhipong","year":"2023","journal-title":"Alzheimers Dement."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"363-375","DOI":"10.3233\/JAD-240037","article-title":"Prevalence and determinants of diagnosed dementia: a registry linkage study linking diagnosis of dementia in the population-based HUNT study to registry diagnosis of dementia in primary care and Hospitals in Norway.","volume":"99","author":"L Gj\u00f8ra","year":"2024","journal-title":"J Alzheimers Dis."},{"key":"ref-4","article-title":"Journey through the diagnosis of dementia.","author":"S Gauthier","year":"2021"},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"887-914","DOI":"10.1007\/s41669-023-00440-z","article-title":"Cost-effectiveness of non-pharmacological interventions for mild cognitive impairment and dementia: a systematic review of economic evaluations and a review of reviews.","volume":"7","author":"G Eaglestone","year":"2023","journal-title":"Pharmacoecon Open."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"1-226","DOI":"10.3310\/hta18390","article-title":"A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia.","volume":"18","author":"G Livingston","year":"2014","journal-title":"Health Technol Assess."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"669-76","DOI":"10.1007\/s12603-010-0314-4","article-title":"Dementia case management effectiveness on health care costs and resource utilization: a systematic review of randomized controlled trials.","volume":"14","author":"C Pimouguet","year":"2010","journal-title":"J Nutr Health Aging."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"273-89","DOI":"10.1586\/14737167.8.3.273","article-title":"Systematic review of economic evaluations of Alzheimer's Disease medications.","volume":"8","author":"M Oremus","year":"2008","journal-title":"Expert Rev Pharmacoecon Outcomes Res."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"789-802","DOI":"10.2165\/11631830-000000000-00000","article-title":"Economic evaluation of treatment options in patients with Alzheimer's Disease: a systematic review of cost-effectiveness analyses.","volume":"72","author":"L Pouryamout","year":"2012","journal-title":"Drugs."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"1593-605","DOI":"10.1017\/S1041610218001291","article-title":"Where are we at with model-based economic evaluations of interventions for dementia? A systematic review and quality assessment.","volume":"30","author":"K Nguyen","year":"2018","journal-title":"Int Psychogeriatr."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"681-707","DOI":"10.1007\/s40273-016-0392-1","article-title":"Systematic review of model-based economic evaluations of treatments for Alzheimer\u2019s Disease.","volume":"34","author":"L Hernandez","year":"2016","journal-title":"Pharmacoeconomics."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"g7647","DOI":"10.1136\/bmj.g7647","article-title":"Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols (PRISMA-P) 2015: elaboration and explanation.","volume":"350","author":"L Shamseer","year":"2015","journal-title":"BMJ."},{"key":"ref-13","article-title":"Extended data file - Economic evaluations of strategies targeting pre-diagnosis dementia populations: protocol for a Systematic Review","author":"M Hoang"},{"key":"ref-14","doi-asserted-by":"publisher","first-page":"336-41","DOI":"10.1016\/j.ijsu.2010.02.007","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.","volume":"8","author":"D Moher","year":"2010","journal-title":"Int J Surg."},{"key":"ref-15","article-title":"Methods for the economic evaluation of health care programmes.","author":"M Drummond","year":"2015"},{"key":"ref-16","doi-asserted-by":"publisher","first-page":"270-9","DOI":"10.1016\/j.jalz.2011.03.008","article-title":"The diagnosis of mild cognitive impairment due to Alzheimer's Disease: recommendations from the national institute on aging-alzheimer's association workgroups on diagnostic guidelines for Alzheimer's Disease.","volume":"7","author":"M Albert","year":"2011","journal-title":"Alzheimers Dement."},{"key":"ref-17","doi-asserted-by":"publisher","first-page":"51-59","DOI":"10.1332\/174426410x482999","article-title":"A web-based tool for adjusting costs to a specific target currency and price year.","volume":"6","author":"I Shemilt","year":"2010","journal-title":"Evidence & Policy."},{"key":"ref-18","doi-asserted-by":"publisher","first-page":"1312-1314","DOI":"10.1001\/jama.2023.1792","article-title":"Cost-effectiveness thresholds used by study authors, 1990\u20132021.","volume":"329","author":"P Neumann","year":"2023","journal-title":"JAMA."},{"key":"ref-19","doi-asserted-by":"publisher","first-page":"1-503","DOI":"10.3310\/hta19140","article-title":"Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold.","volume":"19","author":"K Claxton","year":"2015","journal-title":"Health Technol Assess."},{"key":"ref-20","article-title":"Cochrane handbook for systematic reviews of interventions version 6.5 (updated August 2024): Chapter 20: Economic evidence.","author":"T Higgins","year":"2024"},{"key":"ref-21","doi-asserted-by":"publisher","first-page":"10-31","DOI":"10.1016\/j.jval.2021.10.008","article-title":"Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 explanation and elaboration: a report of the ISPOR CHEERS II good practices task force.","volume":"25","author":"D Husereau","year":"2022","journal-title":"Value Health."}],"container-title":["HRB Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-11\/v3\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-11\/v3\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-11\/v3\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T10:19:09Z","timestamp":1777371549000},"score":1,"resource":{"primary":{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-11\/v3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":21,"URL":"https:\/\/doi.org\/10.12688\/hrbopenres.14064.3","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/hrbopenres.14064.2","asserted-by":"subject"},{"id-type":"doi","id":"10.12688\/hrbopenres.14064.1","asserted-by":"subject"}]},"ISSN":["2515-4826"],"issn-type":[{"value":"2515-4826","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,29]]},"assertion":[{"value":"Indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-11\/v3#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/hrbopenres.15492.r46271, Joseph Kane, Queen's University Belfast, Belfast, 05 Mar 2025, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-11\/v2#referee-response-46271","order":0,"name":"referee-response-46271","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Men Hoang<\/b>; \nPosted: 26 Sep 2025<\/i>; Thank you, Dr. Kane, for your comments; they definitely help us enhance the clarity of our protocol.","URL":"https:\/\/hrbopenresearch.org\/articles\/8-11\/v3#referee-comment-3818","order":1,"name":"referee-comment-3818","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.15492.r46288, Jiaer Lin, The Chinese University of Hong Kong (CUHK), Hong Kong, 22 Mar 2025, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-11\/v2#referee-response-46288","order":2,"name":"referee-response-46288","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Men Hoang<\/b>; \nPosted: 26 Sep 2025<\/i>; Thank you for taking the time to review our protocol. \nIntroduction:<\/b> \n1. Is there any definition for pre-diagnosis stage in either clinical practice or research?<\/b> \nResponse:<\/b> Thank you for your comments. In the literature, we found this paper defined \u201c"Pre-diagnosis was defined as the period from the initial onset of symptoms up to the formal diagnosis\u201d. (https:\/\/doi.org\/10.1017\/S1041610217000862) In our review, we added a sentence to clarify the definition of the pre-diagnosis dementia population as \u201cindividuals who have not yet been formally diagnosed\u201d. \u201cThus, it is essential to identify and implement cost-effective strategies targeting individuals who have not yet been formally diagnosed (i.e., those in the pre-diagnosis dementia populations) to help reduce the rising impact of dementia\u201d. \n2. What\u2019s the differences with MCI? If prior research have already reviewed those MCI, what value of this research will be contributed to? Response: <\/b>In our review, pre-diagnosis dementia populations are broader than MCI. In the introduction, we added a sentence for clarification. \u201cHowever, a comprehensive review encompassing all strategies specifically targeting pre-diagnosis dementia populations, which include the general population, at-risk groups, and individuals with MCI without detectable AD pathology, is lacking in the literature.\u201d \nMethods: Eligibility<\/b> \n1. For the target population, how to identify if the articles includes individuals at any stage prior dementia diagnosis? By what definition or any tests (e.g., MMSE) used? If by tests, what results are considered to be eligible? <\/b> \nResponse: <\/b>1. We identified the target population according to how the authors described the target populations in their economic evaluations. We added following sentence in our protocol: \u201cThe pre-diagnosis dementia population is typically defined by authors who explicitly state that their studies start with a cohort described as having \u201cno dementia,\u201d or as comprising individuals with mild cognitive impairment (MCI) or at-risk population.\u201d \n2. Intervention: Would it be possible that (3) non-pharmacotherapy have already included (4) management strategies at home, in the community, and in long-term care?<\/b> \nResponse<\/b>: We revised the protocol and categorised interventions into three groups: identification, risk reduction, and others. The latter group will compass studies that do not fall into either identification or risk reduction. \n3. Outcomes: Please specify what perspective the authors decided to adopt when reporting the cost outcomes, will the authors include all cost items? Or only for one perspective? If for all, how about costs that published in separate articles?<\/b> \nResponse: <\/b> We do not adopt any perspective whilst critically appraising the literature. But rather, we "document stated perspectives" . We extracted the average total cost and intervention cost (if reported) as they may (or may not) relate to stated perspectives. \n4. Study design: - Trail-based and model-based EEs are very different study types. For model-based, additional information such as modeling technique, parameters, etc.  are important and should also be considered and specified clearly.     Response:<\/b> We include articles as long as they are considered full economic evaluations according to Drummond\u2019s classification scheme. This means we include both trial-based and model-based full economic evaluations. \n- Will the authors consider include multiple (\u22652) articles that published for the same intervention for different outcomes, say cost outcomes in one article and effectiveness such as clinical outcomes in anthter. Response<\/b>: The data extraction stage is a memoryless process and no attempt is made to cross reference studies to check if multiple articles were published from the same study of a single intervention. However, at analysis, where there is sufficient evidence of duplication of reporting the same findings, the study would be flagged as such. \nData synthesis<\/b> \n1. There are three guidelines that provides instructions of conducting systematic review on cost-effectiveness studies (Cochrane HandBook, CRD from York,  and ISPOR), the authors should consider to follow one of each for the data synthesis process. Response: <\/b>Thank you for your suggestion. All systematic review processes aim to adhere to standards set out in the Cochrane Handbook and specifically Chapter 20: Economic evidence. The results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The template for summarising data extracted from each individual study was based on the former template of CRD NHS EED database. \n2. The authors stated that "Where studies report both total costs and outcomes expressed in QALYs, results will be adjusted and will be visually presented on a cost-effectiveness plane to facilitate decision-making." The authors should clarify more details for the following points; - How to adjust the results? - How about costs in different countries? Any standardized method will be used?     Response:<\/b> Thanks to your comment, we identify there is an error in our statement (i.e it should be incremental cost not total cost).The cost-effectiveness plane is used solely for illustrative purposes but adjustments are required:We used CPI and PPP method, converted cost to international dollar in 2024 prices. We added in the protocol as:\u201cthe incremental cost will be converted to international dollars (value in 2024) using the purchasing power parity from the International Monetary Fund dataset \n17<\/sup>, and visually presented on a cost-effectiveness plane to facilitate comparison.\u201d \n- What threshold of williness-to-pay will the authors use to present the cost-effectiveness plane?  Response<\/b>: Two willingness-to-pay (WTP) benchmarks were used to demonstrate the comparative cost-effectiveness of the strategies: $150,000 per QALY, indicative of the relatively unregulated market context in the United States (US) 18, and £12,936 per QALY, representing the more resource-limited system in the United Kingdom (UK)19. These values were selected to capture the range between higher and lower reference points. \n- Will this study conclude with which strategy is cost-effective\/cost-saving or not, how? Response: <\/b>Based on the CE-plane, we can see if the intervention is in the dominant quadrant. The cost-effectiveness plane is used solely for illustrative purposes, we will not alter the original conclusion regarding the cost-effectiveness of the included articles. The intention of this review is not to determine whether any given strategy is cost effective or not (because, as the reviewer indicates, different countries will have different willingness to pay threshold). Rather, the intention is to systematically identify and critical appraisal all relevant studies. By extension, the illustration on the cost effectiveness plane provide a synthesis for comparison of the relative efficiency of each approach, however, this is not intended to endorse use in any jurisdiction but rather encourage countries to conduct their own country level appraisal (in which they may opt to adapt analyses highlighted by our review). \n- There are others details need to consider especially for model-based EEs. The authors could reconsider whether to include model-based studies or not? Response:<\/b> The article is intended to provide a compendium of all EEs for non-economist audience and, as part of the wider work, we wish this to help readers understand there are two main sources of cost-effectiveness evidence. \nQuality appraisal<\/b> \nIn addition to the methodological quality of the EEs, the authors should also evaluate the publication bias of the included studies, following the Cochrane guideline. The authors can take our prior systematic review as reference for the methodology. Response:<\/b> Thank you for your advice. In EE, we do not have publication bias estimation. But in many reviews, they estimate the publication  bias of the included intervention. We are not doing that in this review. Once again, thank you very much for providing comments. We believe that your comments will help us in improving the clarification and transparency of this protocol ","URL":"https:\/\/hrbopenresearch.org\/articles\/8-11\/v3#referee-comment-3819","order":3,"name":"referee-comment-3819","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.15492.r46287, Amritpal Rehill, London School of Economics and Political Science, London, 27 Mar 2025, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-11\/v2#referee-response-46287","order":4,"name":"referee-response-46287","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Men Hoang<\/b>; \nPosted: 26 Sep 2025<\/i>; \n1. It might be a good idea to briefly discuss how accurately we can currently predict who may or may not go on to have dementia in the future. It was mentioned that pharmacological interventions in the pre-diagnosis context were to be considered- presumably it would be preferred to go ahead with this for those we are particularly confident will go on to be diagnosed with dementia.<\/b> \nResponse:<\/b> We appreciate your review of our protocol and the insightful comments you provided. We will think about this point in our review and discuss its implications for identifying appropriate target populations. \n2. Is there a cut-off in terms of how old a study can be to be included in the review? Response: <\/b>Thank you for your thoughtful comment. We include all publications from January 1, 2000, to January 14, 2025. We added a sentence in the protocol: \u201cWe searched for articles published between January 1, 2000, and January 14, 2025.\u201d \nTied to this, for older studies, something that might be considered is that costs for different components of the interventions may be different now compared to in the past (especially if technology was involved, or if specific drugs are no longer under patent). It might be that cost-effectiveness of some interventions may be different if the intervention were provided today, however without being able to repeat the original study this might need to be listed as a limitation. Response:<\/b> In our review: 1) We adjust cost of intervention up to 2024 value and convert to int$  2) We will consider mentioning this limitation of simple adjustments in discussing the final paper.  \n3. Tied to the above, under study details extracted, it may be useful for the year(s) in which the intervention was administered to be extracted. Response:<\/b> Thank you for your comment. In our review, we extract the year of publication and price year when costs were reported (if available). \n4. On similar lines to time, place may also play a factor in determining cost-effectiveness. As an example, for a given intervention, studies from the US and UK may suggest it is cost-effective, but there might not be studies from other countries and there might be reasons so suggest cost-effectiveness might not hold true in other settings (e.g. in developing countries), where costs may differ.       Response: 4.<\/b> Thank you for your suggestion. Indeed, we will have a paragraph to discuss country-specific decision-making in considering the cost-effectiveness of interventions in our review manuscript based on the final extracted data. \nI was wondering if the authors were planning to evaluate\/comment on the generalisability of the resulting cost-effectiveness estimates Response:<\/b> Two willingness-to-pay (WTP) benchmarks were used to demonstrate the comparative cost-effectiveness of the strategies: $150,000 per QALY, indicative of the relatively unregulated market context in the United States (US) 18, and £12,936 per QALY, representing the more resource-limited system in the United Kingdom (UK)19. These values were selected to capture the range between higher and lower reference points. The cost-effectiveness plane is used solely for illustrative purposes, we will not alter the original conclusion regarding the cost-effectiveness of the included articles. \n5. Alongside evaluating cost-effectiveness, I was wondering if there were any plans to discuss potential differences regarding implementation. For example, a group intervention studied in the US\/UK may have been found to be cost-effective, but for those living in a different country where there is more stigma around dementia, individuals may not want to attend group sessions to receive the intervention. I appreciate that this is not the core focus of the study, but I think providing a brief description of this to speak to the generalisability of results where studies exist only in a few similar countries\/settings would help to contextualise the findings. Response:<\/b> Thank you for your thoughtful comment. We will take your suggestion into account in the discussion section of our review. Exploration of whether included studies were actually implemented is a very good suggestion but is unfortunately beyond the scope at this time. In the final paper, we will discuss this as a recommendation from this review. The point on generalisability is well taken and, at this protocol paper stage (for the benefit of non-economists. \n6. It is fantastic to see that the focus is not only on cost-effectiveness but also on methods and methods used to calculate costs. Currently there is no consensus on how best to value hours of unpaid care (e.g. replacement cost approach or opportunity cost approach), and this decision can have a large impact on the ultimate cost-effectiveness calculation. This alongside other methodological decisions being noted\/tracked\/compared should prove useful.    Response: <\/b>Thank you for your comment. For each included article, we will summarise its details, such as: title, purpose, country, funding source, type of EE, study design, type of model (if applicable), time horizon, perspective, population, intervention, comparator, resource measurement, utility measurement, uncertainty analysis, currency and price year, discount, quality of article in terms of our newly developed framework to provide an objecty score from CHEERS checklist, economic measure in terms of total cost, total QALY, incremental cost and QALY, intervention cost. We wholeheartedly agree with this limitation in the literature and, informed by and conducted in parallel to this review, we are conducting work to reach greater consensus (Trepel, D. (2019). Core outcome set for economic evaluation of dementia interventions. COMET Initiative. Retrieved April 7, 2025, from https:\/\/www.comet-initiative.org\/Studies\/Details\/1737). This review, along with reviews of post diagnostic EEs (Scanlon, H., Saha, S., Trepel, D. (2024). Economic evaluations of interventions for people living with dementia and their caregivers: A systematic review and core outcome set of resource use. ResearchGate), are extracting data on varying resource use data, and this will inform a consensus exercise to ultimately produce a core outcomes set for future dementia economic evaluation. To extend this discussion, we will also extract which unit costs are applied to informal care across EEs.","URL":"https:\/\/hrbopenresearch.org\/articles\/8-11\/v3#referee-comment-3820","order":5,"name":"referee-comment-3820","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This study was funded by the Global Brain Health Institute, Economics of Brain Health Project (Project no. 212322). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":6,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}