The cost-effectiveness of a nonpharmacologic intervention for individuals with dementia and family caregivers: The tailored activity program

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.