The Cost‐Effectiveness of a Behavior Intervention with Caregivers of Patients with Alzheimer's Disease

Abstract

Objectives-To examine the cost-effectiveness of a randomized, clinical trial of a home-based intervention for caregivers of people with dementia. Setting-Community-dwelling dementia caregiving dyads from the Memphis REACH II site. Design-This Participants-OfMemphis' 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.Address correspondence to Linda O. Nichols, PhD, VAMC (11-H), 1030 Jefferson Avenue, Memphis, TN 38104. E-mail: linda.nichols@va.gov. Author Contributions: Dr. Nichols had full access to all the data in the study and takes responsibility for the integrity for the data and the accuracy of the data analysis. All contributors are included as authors. Study concept and design: Burns, Chang, Czaja, Nichols. Acquisition of data: Coon, Lummus, Martindale, Nichols. Analysis and interpretation of data: Burns, Chang, Czaja, Graney, Lummus, Nichols. Drafting of the manuscript: Chang, Lummus, Nichols. Critical Revision of the manuscript for important intellectual content: Burns, Chang, Coon, Czaja, Graney, Martindale, Nichols. Statistical analysis: Graney, Lummus. Obtaining funding: Burns, Coon, Martindale, Nichols. Administrative, technical, or material support: Burns, Coon, Czaja, Graney, Lummus, Martindale, Nichols. Supervision: Martindale, Nichols. Sponsor's Role:No sponsors were involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation or review of the manuscript. The Department of Veterans Affairs approved the manuscript. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptIntervention(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. The 6-month intervention included modules focusing on information, safety, caregiver health and well-being, and behavior management for the care recipient. Twelve individual sessions were delivered in the caregivers' home (9 sessions) and through telephone (3 sessions), supplemented by five telephone-administered support...

Effectiveness of Supporting Informal Caregivers of People with Dementia: A Systematic Review of Randomized and Non-Randomized Controlled Trials

“…They found significant reduction in hours of care (primary outcome) provided by the caregiver and concluded that the intervention was also cost-effective [84].…”

Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review (Preprint)

“…physical and psychological impairments, impacting less on the healthcare system from an economic or a social perspective [15,16]. Literature reviews and meta-analyses confirm the association between greater mental burden and poorer physical and mental well-being: the responsibilities and the stressful experiences related to the caregiving role can cause depression, anxiety, worry and loneliness [17][18][19][20][21][22].…”

Estresse em cuidadores de pacientes com Alzheimer: uma revisão de literatura

“…Considerando a diversidade etnica, cuidadores hispânicos e caucasianos, participantes das intervenções, experimentaram melhora significativa na qualidade de vida do que aqueles do grupo controle; sugerindo que a depressão clínica foi menor entre os cuidadores do grupo de intervenção (Belle, Burgio, Burns, Coon, Czaja, Gallagher-Thompson, Gitlin, Klinger, Koepke, Lee, Martindale-Adams, Nichols, Schulz, Stahl, Stevens, Winter & Zhang, 2006) Os custos emocionais e físicos da prestação de cuidados nos casos de demência são relevantes e a intervenção se mostra capaz de amenizar esses custos emocionais e físicos (Nichols, Chang, Lummus, Burns, Martindale-Adams, Graney, Coon & Czaja, 2008). Essas intervenções centram-se em fornecer ao cuidador informações sobre a enfermidade de seus pacientes, psicoeducação, aconselhamento psicológico ou mesmo acompanhamento psicoterápico breve (Glueckauf et al, 2012;Cheng et al,2012;Blom et al, 2013), das opções de psicoterapia breve, a que se destaca na literatura como alternativa de controle de estresse também nesses casos é a Terapia Cognitivo Comportamental (TCC) (Cheng et.…”