Cited by 87Health Systems, Economic Evaluations, Quality of LifeDementia and Cognitive Impairment ResearchFamily Caregiving in Mental Illness

Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial

Open access
Knapp, M., King, D., Romeo, R., Schehl, B., Barber, J., Griffin, M., Rapaport, P., Livingston, D. +6 more·2013·BMJ

Abstract

OBJECTIVE: To assess whether the START (STrAtegies for RelatTives) intervention added to treatment as usual is cost effective compared with usual treatment alone. DESIGN: Cost effectiveness analysis nested within a pragmatic randomised controlled trial. SETTING: Three mental health and one neurological outpatient dementia service in London and Essex, UK. PARTICIPANTS: Family carers of people with dementia. INTERVENTION: Eight session, manual based, coping intervention delivered by supervised psychology graduates to family carers of people with dementia added to usual treatment, compared with usual treatment alone. PRIMARY OUTCOME MEASURES: Costs measured from a health and social care perspective were analysed alongside the Hospital Anxiety and Depression Scale total score (HADS-T) of affective symptoms and quality adjusted life years (QALYs) in cost effectiveness analyses over eight months from baseline. RESULTS: Of the 260 participants recruited to the study, 173 were randomised to the START intervention, and 87 to usual treatment alone. Mean HADS-T scores were lower in the intervention group than the usual treatment group over the 8 month evaluation period (mean difference -1.79 (95% CI -3.32 to -0.33)), indicating better outcomes associated with the START intervention. There was a small improvement in health related quality of life as measured by QALYs (0.03 (-0.01 to 0.08)). Costs were no different between the intervention and usual treatment groups (£252 (-28 to 565) higher for START group). The cost effectiveness calculations suggested that START had a greater than 99% chance of being cost effective compared with usual treatment alone at a willingness to pay threshold of £30,000 per QALY gained, and a high probability of cost effectiveness on the HADS-T measure. CONCLUSIONS: The manual based coping intervention START, when added to treatment as usual, was cost effective compared with treatment as usual alone by reference to both outcome measures (affective symptoms for family carers, and carer based QALYs). TRIAL REGISTRATION: ISCTRN 70017938.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1136/bmj.f6342

Cites

25 of 25 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

3 of the 28 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [21]National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. NICE, 2008. 27905712

Cited by

Sorted by citations

Authors
Knapp, M., King, D., Romeo, R., Schehl, B., Barber, J., Griffin, M., Rapaport, P., Livingston, D., Mummery, C., Walker, Z., Hoe, J., Sampson, E. L., Cooper, C., & Livingston, G.
Affiliations
  • King's College London (GB)
  • London School of Economics and Political Science (GB)
  • University College London (GB)
  • The Royal Free Hospital (GB)
  • Camden and Islington NHS Foundation Trust (GB)
Corresponding author
Knapp, M.
Venue
BMJ
Publisher
BMJ
Published
2013-10-25
Volume
347
Issue
oct25 2
Pages
f6342-f6342
ISSN
1756-1833 (ISSN-L)
OpenAlex
W1995837661
Cited by
87
References
28
Citations by year
2026: 1 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 7 · 2020: 3 · 2019: 7 · 2018: 7 · 2017: 12 · 2016: 11 · 2015: 8 · 2014: 12 · 2013: 3
FWCI
26.60
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, other-oa)
  • London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (acceptedVersion, cc-by-nc)
  • London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
  • City Research Online (City University London) (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • London School of Economics and Political Science
  • National Institute for Health and Care Research (08/14/06, 08/14/99)
  • Marie Curie (MCCC-FCO-11-U)
  • King's College London
  • University College London
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
Keywords
family caregivers, dementia, coping interventions, cost-effectiveness, anxiety, depression, affective symptoms, quality-adjusted life years, health-related quality of life, manual-based intervention
MeSH terms
Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Anxiety, Cost-Benefit Analysis, Dementia, Depression, Female, United Kingdom, Humans, Male, Manuals as Topic, Middle Aged, Psychological Tests, Psychotherapy, Quality of Life, Surveys and Questionnaires, Linear Models, Treatment Outcome, Caregivers, Health Care Costs, Quality-Adjusted Life Years, Intention to Treat Analysis

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review