The Cost-Effectiveness of a Nonpharmacologic Intervention for Individuals With Dementia and Family Caregivers: The Tailored Activity Program

doi:10.1097/JGP.0b013e3181c37d13

The American Journal of Geriatric Psychiatry

Volume 18, Issue 6, June 2010, Pages 510-519

https://doi.org/10.1097/JGP.0b013e3181c37d13 Get rights and content

Objectives:

To evaluate cost-effectiveness of the Tailored Activity Program (TAP) for individuals with dementia and family caregivers.

Design:

Cost-effectiveness study of a two-group randomized controlled trial involving 60 patients-caregiver dyads randomized to intervention or wait-list control.

Setting:

Participants' homes in Philadelphia region.

Participants:

Caregivers were aged ≥21 years, lived with patients, and provided ≥4 hours of daily care. Patients had moderate dementia and behavioral symptoms

Intervention:

Eight sessions of occupational therapy over 4 months to identify patients' preserved capabilities, previous roles, habits and interests, develop customized activities, and train families in their use.

Measurements:

Incremental cost-effectiveness ratios (ICER) expressed as the cost to bring about one additional unit of benefit measured by caregiver hours per day “doing things” and hours per day “being on duty.” Decision tree and Monte Carlo analyses tested robustness of the economic models.

Results:

Total average intervention cost was $941.63 per day. Intervention caregivers saved one extra hour per day “doing things” at a cost of $2.37/day and one extra hour per day “being on duty” at a cost of $1.10/day. Monte Carlo showed that TAP was cost-effective 79.2% of the time for “doing things” and 79.6% of the time for “being on duty.” Varying the cost assumptions did not change cost-effectiveness.

Conclusions:

Findings suggest that investment in TAP is cost-effective and afforded families an important, limited and highly valued resource, needed time off from caregiving. This nonpharmacologic approach should be considered part of the clinical management of dementia.

Section snippets

Study Design and Sample

The cost-effectiveness analysis was consistent with the original TAP trial design as reported previously.²⁴ Briefly, using a two-group parallel design, 60 dyads (patients with dementia/caregivers) were recruited between 2005 and 2006 and randomly assigned to treatment or wait-list control. Treatment group participants received TAP, whereas the wait-list control group did not receive any study-related contact. At 4-months from baseline, all dyads were reassessed on study outcomes. Four

RESULTS

The study sample of patients with dementia were primarily men (57%) and white (77%), with a mean age of 79 years. On average, they had a Mini-Mental State Examination score of 11.6 (SD = 8.1), were dependent in eight (SD = 0.90) instrumental and five (SD = 2.2) basic activities of living, and manifested an average of 7.8 (SD = 4.1) behaviors (e.g., repetitive vocalization, shadowing, and agitation).33., 34.

Caregivers were primarily women (88%), white (77%), high school graduates (56%), and

DISCUSSION

The vast majority of individuals with dementia are cared for at home by family members. With disease progression, families must devote more time providing hands-on assistance and oversight such that time becomes a precious commodity. Programs that offer respite or time away from both tangible (task performance) and intangible (vigilance) caregiving can help alleviate caregiver burden.

This study examined the cost-effectiveness of a home-based intervention that provides activities customized to

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The authors acknowledge the significant contributions of our research staff and study participants for their time and effort in this study.

This work was supported in part by funds from the NIMH (Grant no. R21 MH069425).

Presented, a version of this article, at the International Conference on Alzheimer's Disease July 12, 2009, Vienna.

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Regular Research ArticlesThe Cost-Effectiveness of a Nonpharmacologic Intervention for Individuals With Dementia and Family Caregivers: The Tailored Activity Program

Objectives:

Design:

Setting:

Participants:

Intervention:

Measurements:

Results:

Conclusions:

Section snippets

Study Design and Sample

RESULTS

DISCUSSION

Alzheimers Dement

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

J Psychiatr Res

Arch Gerontol Geriatr

Informal costs of dementia care: estimates from the National Longitudinal Caregiver Study

J Gerontol B Psychol Sci Soc Sci

The effects of patient function and dependence on costs of care in Alzheimer's disease

J Am Geriatr Soc

The cost of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Alzheimer's disease patients

Int J Geriatr Psychiatry

The expert consensus guideline series. Treatment of dementia and its behavioral disturbances. Introduction: methods, commentary, and summary

Postgrad Med

Impact of behavioral and psychological symptoms of dementia on caregivers

Int Psychogeriatr

Behavioral and psychological symptoms of dementia and caregivers' stress appraisals: intra-individual stability and change over short-term observations

Aging Ment Health

Influence of behavioral symptoms on rates on institutionalization for person's with Alzheimer's disease

Psychol Med

The incremental direct costs associated with behavioral symptoms in AD

Neurology

Review: pharmacological and non-pharmacological interventions improve outcomes in patients with dementia and in their caregivers

Evid Based Ment Health

Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy

J Clin Psychiatry

Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease

N Engl J Med

Nonpharmacological interventions for inappropriate behaviors in dementia

Alzheimers Care Q

Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial

JAMA

Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer's disease and related disorders

J Gerontol A Biol Sci Med Sci

Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis

Br J Psychiatry

Regular Research Articles
The Cost-Effectiveness of a Nonpharmacologic Intervention for Individuals With Dementia and Family Caregivers: The Tailored Activity Program