Birkenhäger-Gillesse Elizabeth G, Achterberg Wilco P, Janus Sarah I M, Zuidema Sytse U, van den Hout Wilbert B
Department of General Practice and Elderly Care Medicine University of Groningen University Medical Center Groningen Groningen the Netherlands.
Laurens Care Centers Rotterdam the Netherlands.
Alzheimers Dement (N Y). 2022 Jun 22;8(1):e12281. doi: 10.1002/trc2.12281. eCollection 2022.
We evaluated the cost-effectiveness of the "More at Home with Dementia" intervention, a multicomponent training program for co-residing caregivers of people with dementia (PwDs).
We performed a two-armed randomized controlled trial with an intervention and a control group. Participants were community-dwelling caregivers living with a person with dementia (59 randomized to intervention and 50 to control arm). The training program lasted 5 days and took place in a holiday accommodation. Quality-adjusted life-years (QALYs) were calculated using the EuroQol-5 Dimensions 3 Levels (EQ-5D-3L) for caregivers and PwDs. Costs for informal and formal social care, as well as health care, were collected at four times over a 6-month period from baseline. Information on nursing home admission or death was collected for 2 years after baseline.
QALYs for caregivers and PwDs added together were 0.12 higher in the intervention group compared with the control group ( = .11). After 1 year, there tended to be fewer nursing home admissions in the intervention group, but this difference was lost by 2 years ( = .19). The cost of the intervention was estimated at €1000 (USD 1090) per dyad. Compared with the control group, the intervention group used other health care and formal social care significantly less for a year after baseline ( = .02 and .001, respectively). The estimated decrease in total costs was €10,437 ( = .07), with an estimated 96% probability that the intervention was cost-effective vs usual care.
The multicomponent "More at Home with Dementia" training program is effective and appears to save costs compared with usual care. Savings appear to be achieved by delaying nursing home admissions and by reducing the use of other care resources. Further research is also needed to clarify if this intervention is effective for caregivers who do not live with a PwD, such as adult children, and for the caregivers of patients with other debilitating chronic diseases. At the same time, effort is advised to implement caregiver training in standard care programs.
我们评估了“痴呆症居家更多关怀”干预措施的成本效益，这是一项针对与痴呆症患者（PwD）共同居住的照护者的多组分培训项目。
我们进行了一项双臂随机对照试验，分为干预组和对照组。参与者是与痴呆症患者共同居住的社区照护者（59人随机分配至干预组，50人分配至对照组）。培训项目持续5天，在一个度假住所进行。使用欧洲五维度健康量表3级（EQ - 5D - 3L）计算照护者和痴呆症患者的质量调整生命年（QALY）。在6个月期间，从基线开始分四次收集非正式和正式社会护理以及医疗保健的费用。在基线后2年收集有关养老院入住或死亡的信息。
与对照组相比，干预组照护者和痴呆症患者的QALY总和高0.12（P = 0.11）。1年后，干预组的养老院入住人数往往较少，但到2年时这种差异消失了（P = 0.19）。干预措施的成本估计为每对1000欧元（1090美元）。与对照组相比，干预组在基线后一年使用其他医疗保健和正式社会护理的情况明显减少（分别为P = 0.02和P = 0.001）。总成本估计减少了10437欧元（P = 0.07），估计该干预措施与常规护理相比具有成本效益的概率为96%。
与常规护理相比，多组分的“痴呆症居家更多关怀”培训项目是有效的，且似乎能节省成本。节省成本似乎是通过延迟养老院入住和减少其他护理资源的使用来实现的。还需要进一步研究来阐明该干预措施对不住在一起的照护者（如成年子女）以及患有其他衰弱性慢性病患者的照护者是否有效。同时，建议努力在标准护理项目中实施照护者培训。
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