The cost-effectiveness of a behavior intervention with caregivers of patients with Alzheimer's disease

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.