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88 Interventions in Alzheimer’s Disease KCE Reports 111 Study Nichols LO, Chang C, Lummus A, Burns R, Martindale-Adams J, Graney MJ, et al. The cost-effectiveness of a behavior intervention with caregivers of patients with Alzheimer's disease. J Am Geriatr Soc. 2008;56(3):413-20. Country USA Design RCT-based economic evaluation Non probabilistic evaluation CEA Perspective Not stated but limited to a Straff+Caregivers’ costs perspective Time window 6 months Interventions Caregiver support 6 months intervention including modules focusing on information, safety, caregiver health and well-being, and behaviour management. Organization: 9 individual sessions delivered in the caregiver’s home + 3 individual phone sessions + 5 support group sessions of five to six caregivers. Comparators: 2 brief “check-in” phone calls Population Caregivers of patients diagnosed with AD or dementia N = 92 caregivers Assumptions Data from the REACH II trial (Resources for Enhancing Alzheimer’s Caregivers Health) Data source for costs Cost items included Data source for outcomes Discounting Not applicable Costs Only the intervention direct and indirect costs are considered – no medical costs Local actual costs for direct costs Opportunity costs for indirect costs US$ - Costing year not stated Direct costs: - Intervention: staff training, preparation and supervision + staff travel + material - Comparator: staff training, preparation and supervision + material Indirect costs: - Intervention: time spent by the caregiver to assist the interventions’ sessions - Control: time spent by the caregiver to assist the phone sessions Decrease in the amount of time spent by the caregiver in caregiving activities. Hours of non-caregiving gained or caregiving hours avoided Intervention Control Staff costs $1047 $50 Caregiver costs $167 $4 Total costs $1214 $54 Outcomes Reduction in caregiving hours (baseline versus 6 months): - Intervention: 1.3 hours per day - Control: 0 hours per day Cost- Caregiving hours avoided: 1.3 hours per day (or 234 hours per 6 months)
KCE Reports 111 Interventions in Alzheimer’s Disease 89 effectiveness Sensitivity analysis ICost: $1160 (over 6 months) ICER: $4.96 / hour of care avoided. None performed Conclusions According to the authors, this demonstrates that caregiver help is cost-effective. “Intervention costs were only $4.96 per day per caregiver to gain an additional hour of non-caregiving activities” Remarks Outcome measure not validated and rather questionable – basically, no medical effectiveness measure are considered. Selection bias since drop-outs and deaths occurring during the follow-up were simply ignored for the data analysis (no ITT analysis) Only the cost of the intervention (or control) is accounted for, no medical costs. Only the costs of the carer and the staff are accounted for – not the costs of the patients Rather poor quality of the study. This is a poor quality cost study – Discarded!
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