The Cost-Effectiveness of a Nonpharmacologic Intervention for Individuals With Dementia and Family Caregivers: The Tailored Activity Program
Open accessAbstract
Objectives To evaluate cost-effectiveness of the Tailored Activity Program (TAP) for individuals with dementia and family caregivers.Design Cost-effectiveness study of a two-group randomized controlled trial involving 60 patients-caregiver dyads randomized to intervention or wait-list control.Setting Participants' homes in Philadelphia region.Participants Caregivers were aged ≥ 21 years, lived with patients, and provided ≥ 4 hours of daily care. Patients had moderate dementia and behavioral symptoms Intervention Eight sessions of occupational therapy over 4 months to identify patients' preserved capabilities, previous roles, habits and interests, develop customized activities, and train families in their use.Measurements Incremental cost-effectiveness ratios (ICER) expressed as the cost to bring about one additional unit of benefit measured by caregiver hours per day "doing things" and hours per day "being on duty." Decision tree and Monte Carlo analyses tested robustness of the economic models.Results Total average intervention cost was $941.63 per day. Intervention caregivers saved one extra hour per day "doing things" at a cost of $2.37/day and one extra hour per day "being on duty" at a cost of $1.10/day. Monte Carlo showed that TAP was cost-effective 79.2% of the time for "doing things" and 79.6% of the time for "being on duty." Varying the cost assumptions did not change cost-effectiveness.Conclusions Findings suggest that investment in TAP is cost-effective and afforded families an important, limited and highly valued resource, needed time off from caregiving. This nonpharmacologic approach should be considered part of the clinical management of dementia.
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Gitlin et al. and O'Connor et al. described a home-based occupational therapy program based on personal capabilities and individual preferences that promoted a significantly greater reduction in agitation.
“Gitlin et al. [48] and O'Connor et al. [11] described a home-based occupational therapy program based on personal capabilities and individual preferences. This tailored program promoted a significantly greater reduction in agitation.”
From Nonpharmacological Interventions to Reduce Behavioral and Psychological Symptoms of Dementia: A Systematic Review (2015) · cites this paper as [48]
The Methods (Tailored Activity Program; page not provided) describe a largely home-based occupational therapy intervention tailored to patients’ capabilities, previous roles, habits, and interests. The Objective reports significantly fewer behavioral occurrences overall than in the wait-list control group, particularly shadowing and repetitive questioning, but does not report a significantly greater reduction in agitation specifically. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn a randomized controlled trial, Gitlin et al. found that nonpharmacological interventions based on Tailored Activities Program are cost-effective and should be considered as part of the clinical management of dementia.
“In a randomized controlled trial, Gitlin et al. [48] found that nonpharmacological interventions based on Tailored Activities Program are cost-effective and should be considered as part of the clinical management of dementia.”
From Nonpharmacological Interventions to Reduce Behavioral and Psychological Symptoms of Dementia: A Systematic Review (2015) · cites this paper as [48]
Occupational therapy seems effective in reducing behavioral and psychological symptoms of dementia, increasing patient's participation, improving physical performance and quality of life, and reducing negative communication.
“OT seems also effective in reducing BPSD, increasing patient's participation, improving physical performance, and QoL and reducing negative communication (123–129).”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [123]
The Tailored Activity Program was effective in reducing caregiver burden and was highly cost-effective.
“Besides being effective in reducing caregiver burden, in that caregiver had significantly more free time, TAP was demonstrated to be highly cost-effective (123).”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [123]
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“Besides being effective in reducing caregiver burden, in that caregiver had significantly more free time, TAP was demonstrated to be highly cost-effective (123).”
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Self-citation
- Authors
- Gitlin, L. N., Hodgson, N., Jutkowitz, E., & Pizzi, L.
- Affiliations
- Thomas Jefferson University (US)
- Corresponding author
- Gitlin, Laura N.
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 18
- Issue
- 6
- Pages
- 510-519
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC2938079
- OpenAlex
- W2038210589
- Cited by
- 123
- References
- 42
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 5 · 2023: 6 · 2022: 7 · 2021: 12 · 2020: 9 · 2019: 12 · 2018: 10 · 2017: 8 · 2016: 6 · 2015: 7 · 2014: 10 · 2013: 10 · 2012: 3
- FWCI
- 4.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R21MH069425)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Health Professions › Occupational Therapy › Occupational Therapy Practice and Research
- Keywords
- dementia, family caregivers, occupational therapy, non-pharmacological treatment, cost-effectiveness, caregiver burden, behavioral symptoms of dementia, caregiver hours, home-based intervention, decision tree analysis, Monte Carlo simulation
- MeSH terms
- Aged, Aged, 80 and over, Cost-Benefit Analysis, Dementia, Female, Humans, Male, Monte Carlo Method, Occupational Therapy, Caregivers, Health Care Costs
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