THE COSTS AND BENEFITS OF A SCREENING-PROGRAM TO DEFECT DEMENTIA IN OLDER DRIVERS

A Markov model was used to assess the cost-benefit ratios of six strat egies of screening older drivers for mental status, beginning at age 6 5. Probabilities of motor vehicle collisions (MVCs), injuries, and fat alities were obtained from national data. Dementia prevalence, test ch aracteristics, and costs were obtained from the literature. Costs incl uded lost wages, car ownership, alternative transportation, and injuri es. Using a relative risk of MVC for those with dementia of 5 and a 5% annual discounting rate, the average cost per driver ranged from $51, 600 (no testing) to $58,400 (testing every five years). The benefit wa s < one day of life gained, and the benefits of screening cost approxi mately 2.8 million dollars per life-year gained. Increasing the relati ve risk from 5 to 20 substantially improved the cost-benefit of mental status screening. However, mental status screening of older drivers w ould also be cost-beneficial if physician referral costs were lowered to $60 per evaluation. The authors conclude that a dementia screening program for older drivers would be cost-beneficial if physician evalua tions were limited or their cost lowered to less than or equal to $60.