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Table 6 Characteristics of articles comprising psychosocial interventions mainly targeted at the caregiver

From: Health economic evaluations of non-pharmacological interventions for persons with dementia and their informal caregivers: a systematic review

Study, country Type of study and economic evaluation Time horizon C: Cost H: Health outcome Study population, Number of participants IG: Intervention group CG: Control group Outcome measures (measures of benefit) Cost data; source Perspective Results
Joling [29] Netherlands, 2013 RCT CEA CUA C: 12 months H: 12 months Caregivers of community-dwelling PwD and at least one other family member or friend available to take part in the family meetings ▪ 192 randomized caregivers ▪ 87 participants with complete cost and primary outcome data at the follow-up assessment at 12 months IG: Family meetings intervention with six in-person counselling sessions led by trained counselors with a background in a health care related profession. The family meetings aimed to provide psycho-education, problem solving techniques and to mobilize the existing family networks. CG: CAU ▪ MINI caregiver ▪ PwD: proxy-rated SF-12 ▪ Caregiver: SF-12 ▪ PwD QALY ▪ Caregiver QALY ▪ PwD-caregiver dyad QALY ▪ Cost diaries and interview assessments to measure informal care time ▪ Direct and indirect costs of both the caregiver and patient were gathered. Societal perspective Family meetings cannot be considered as cost-effective compared to CAU. No significant differences in total costs between both groups were observed. Ambulatory care costs among caregivers in the intervention group were higher compared to the CAU group. No between groups differences in QALY for both patients and caregivers or on clinical mental parameters for caregivers were found.
Dahlrup [30], Sweden, 2013 Quasi-experimental cohort study, CUA C: up to 60 months H: up to 60 months Family caregivers of recently diagnosed community-dwelling PwDs ▪ 308 randomized participants IG: Psychosocial intervention composed of education and provision of a support group for family caregivers of PwDs (5 weekly counselling sessions, followed by a group discussion). Caregivers who were unable to join group sessions received individual meetings. CG: CAU ▪ Caregivers HRQoL: EQ-5D (two subsets were considered: PwDs still residing in the community and PwDs who had moved to a nursing home) Municipality registers provided data on resource use in terms of home help service and cost of formal care for PwDs and caregivers Not explicitly stated. No group difference in cost was found. Significant higher HRQoL for caregiving children and grandchildren receiving the intervention.
Wray [31] US, 2010 RCT cost analysis C: 12 months Caregivers of community-dwelling veterans with at least a moderate level of dementia who are dependent on their respective caregiver in performing ADL and IADL. Caregivers were spousals, experiencing at least a moderate level of caregiver strain ▪ 158 randomized caregiver-veteran dyads IG: 10-week telephone support group for caregivers of veterans with dementia. The Telehealth Education Program is composed of caregiver education and support CG: CAU Not stated. Health care utilization and cost data derived from the veterans Information System Technology Architecture databases. Data included inpatient, nursing home, outpatient and outpatient pharmacy files. Not explicitly stated. The telephone support groups yielded in significant short term average cost savings of $2,768 per patient at 6 months as compared with CAU, however these were not maintained at 12-month.
Van Houtven [32] US, 2012 RCT cost analysis C: 12 months O: 12 months Caregivers of person’s with AD or Parkinson’s disease ▪ 187 randomized dyads IG: Caregiver skill training over a 24-week period. In-home or telephone-based sessions delivered by a trained nurse CG: Over the same 24-week period the wait-list comparison got social phone contacts administered by persons trained for the provision of socially supportive conversations by phone Not reported. Out-of-pocket costs of caregivers assessed by the caregiving assistance measure (including service use of the care recipient & the caregiver himself) Individual caregiver perspective Caregiver skill training yielded in clinically and statistically significant reduction in caregivers’ depression and improved caregiving mastery. It increased the likelihood of caregivers to experience any out-of-pocket expenditure (OOP) by 26% over usual care; overall OOP costs were not significantly altered.
Livingston [19] UK, 2014 RCT CEA CUA Short-term C: 8 months H: 8 months Long-term C: 24 months H: 24 months Family caregivers providing support at least once a week to community-dwelling PwD ▪ 260 randomized dyads IG: Manual-based individual coping intervention for caregivers delivered in 8 sessions by supervised psychology graduates CG: CAU Primary ▪ Carer: HADS-T Secondary ▪ Carer: QALY derived from the EQ-5D and societal weights CSRI Health and social care perspective The intervention was clinically effective in terms of carers’ anxiety and depression as well as their quality of life. Moreover it was found to be cost-effective in the short and long term when considering caregiver-related cost.
Livingston [18] UK, 2014 RCT CEA CUA Short-term C: 8 months H: 8 months Long-term C: 24 months H: 24 months Family caregivers providing support at least once a week to community-dwelling PwD ▪ 260 randomized dyads ▪ 227 dyads completed 8 months follow-up session ▪ 196 randomized dyads completed 24 months follow-up session IG: Manual-based individual coping intervention for caregivers delivered in 8 sessions by supervised psychology graduates CG: CAU Carer: HADS-T Carer: QALY derived from the EQ-5D and societal weights Patient: QoL-AD (proxy-rated) CSRI Health and social care perspective The intervention was clinically effective and cost-effective in the short and long term when considering carer plus PwD costs.
  1. AD = Alzheimer’s disease, ADL = Activities of Daily Living, CAU = Care as usual, CEA = Cost-effectiveness analysis, CSRI = Client Service Receipt Inventory, CUA = Cost-utility analysis, EQ-5D = EuroQoL 5-dimensions, HADS-T = Hospital Anxiety and Depression Scale (total score), HRQoL = Health-related quality of life, IADL = Instrumental Activities of Daily Living, MINI = Mini International Neuropsychiatric Interview, PwD = Person with dementia, QALY = Quality-Adjusted Life Year, QoL-AD = Quality of Life in Alzheimer’s Disease, RCT = Randomized controlled trial, SF-12 = 12-Item Short Form Health Survey