The cost-effectiveness of a behavior intervention with caregivers of patients with Alzheimer’s disease
Open accessAbstract
OBJECTIVES: To examine the cost-effectiveness of a randomized, clinical trial of a home-based intervention for caregivers of people with dementia. DESIGN: This cost-effectiveness analysis examined Resources for Enhancing Alzheimer's Caregivers Health (REACH II), a multisite, randomized, clinical trial, from June 2002 through December 2004, funded by the National Institute on Aging and the National Institute of Nursing Research, of a behavioral intervention to decrease caregivers' stress and improve management of care recipient behavioral problems. SETTING: Community-dwelling dementia caregiving dyads from the Memphis REACH II site. PARTICIPANTS: Of Memphis' random sample of 55 intervention and 57 control black and white dyads, 46 in each arm completed without death or discontinuation. Family caregivers were aged 21 and older, lived with the care recipient, and had provided 4 or more hours of care per day for 6 months or longer. Care recipients were cognitively and functionally impaired. INTERVENTION(S): Twelve individual sessions (9 home sessions and 3 telephone sessions) supplemented by five telephone support-group sessions. Control caregivers received two "check in" phone calls. MEASUREMENTS: Incremental cost-effectiveness ratio (ICER), the additional cost to bring about one additional unit of benefit (hours per day of providing care). RESULTS: At 6 months, there was a significant difference between intervention caregivers and control caregivers in hours providing care (P=.01). The ICER showed that intervention caregivers had 1 extra hour per day not spent in caregiving, at a cost of $5 per day. CONCLUSION: The intervention provided that most scarce of caregiver commodities--time. The emotional and physical costs of dementia caregiving are enormous, and this intervention was able to alleviate some of that cost.
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Within the United States, a similar therapy delivered at an individual level was found to be significantly cost effective in completers compared with controls for freeing up time spent on care.
“Within the United States, a similar therapy to ours delivered at an individual level was found to be significantly cost effective in completers compared with controls for freeing up time spent on care.38”
From Clinical effectiveness of a manual based coping strategy programme (START, STrAtegies for RelaTives) in promoting the mental health of carers of family members with dementia: pragmatic randomised controlled trial (2013) · cites this paper as [38]
The Abstract and Time Spent Caregiving section report a significant reduction in caregiving hours for intervention caregivers compared with controls. The Incremental Cost-Effectiveness Ratio section finds the intervention cost-effective only if one is willing to spend $4.96 per day for an extra hour of noncaregiving time; it does not report statistically significant cost-effectiveness. The Methods also describe individual sessions supplemented by group calls, rather than an exclusively individual intervention. (LLM, conf=0.85)
Experimental — accuracy not yet measuredWithin the USA, a similar therapy to ours delivered to individuals was found to be significantly cost-effective in completers compared with controls in terms of freeing up caring time.
“Within the USA, a similar therapy to ours delivered to individuals was found to be significantly cost-effective in completers compared with controls in terms of freeing up caring time.21”
That study examined the cost-effectiveness of a modular multicomponent intervention delivered in carers' homes and found a significant difference over the 6-month study period, with carers in the intervention group having more time to dedicate to activities unrelated to caregiving.
“It examined the cost-effectiveness of a modular multicomponent intervention delivered in carers' homes, with three sessions by telephone, supplemented by five group sessions (five or six carers in each) delivered by telephone. Focusing on hours of care-giving, the authors found a significant difference over the 6-month study period, with carers in the intervention group having more time to dedicat”
Only one of the studies covered by that review employed a similar therapeutic approach to the START intervention.
“However, only one of the studies covered by that review employed a similar therapeutic approach to the START intervention.21”
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- Authors
- Nichols, L. O., Chang, C., Lummus, A., Burns, R., Martindale‐Adams, J., Graney, M. J., Coon, D. W., Czaja, S., & for the Resources for Enhancing Alzheimer's Caregivers Health II Investigators
- Affiliations
- University of Miami (US)
- Corresponding author
- Nichols, Linda O.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2007-12-27
- Volume
- 56
- Issue
- 3
- Pages
- 413-420
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC2575686
- OpenAlex
- W1572827656
- Cited by
- 116
- References
- 56
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 4 · 2020: 4 · 2019: 6 · 2018: 4 · 2017: 7 · 2016: 4 · 2015: 9 · 2014: 15 · 2013: 11 · 2012: 11
- FWCI
- 4.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Office of Research and Development
- National Institute on Aging (U01AG013313, U01AG020274, U01-AG13313)
- National Institute of Nursing Research (AG13313)
- 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 › Pharmacy › Nursing care and research
- Keywords
- Alzheimer's disease, dementia caregiving, family caregivers, caregiver stress, behavioral symptoms of dementia, home-based intervention, cost-effectiveness, caregiver time
- MeSH terms
- Aged, Alzheimer Disease, Cost-Benefit Analysis, Female, Health Education, Home Care Services, Humans, Male, Middle Aged, Stress, Psychological, Program Evaluation, Health Behavior, Treatment Outcome, Caregivers, Health Care Costs
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