title: Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial.
abstract: OBJECTIVE
  To assess whether the START (STrAtegies for RelatTives) intervention added to treatment as usual is cost effective compared with usual treatment alone.
  
  
  METHODS
  Cost effectiveness analysis nested within a pragmatic randomised controlled trial.
  
  
  METHODS
  Three mental health and one neurological outpatient dementia service in London and Essex, UK.
  
  
  METHODS
  Family carers of people with dementia.
  
  
  METHODS
  Eight session, manual based, coping intervention delivered by supervised psychology graduates to family carers of people with dementia added to usual treatment, compared with usual treatment alone.
  
  
  METHODS
  Costs measured from a health and social care perspective were analysed alongside the Hospital Anxiety and Depression Scale total score (HADS-T) of affective symptoms and quality adjusted life years (QALYs) in cost effectiveness analyses over eight months from baseline.
  
  
  RESULTS
  Of the 260 participants recruited to the study, 173 were randomised to the START intervention, and 87 to usual treatment alone. Mean HADS-T scores were lower in the intervention group than the usual treatment group over the 8 month evaluation period (mean difference -1.79 (95% CI -3.32 to -0.33)), indicating better outcomes associated with the START intervention. There was a small improvement in health related quality of life as measured by QALYs (0.03 (-0.01 to 0.08)). Costs were no different between the intervention and usual treatment groups (£252 (-28 to 565) higher for START group). The cost effectiveness calculations suggested that START had a greater than 99% chance of being cost effective compared with usual treatment alone at a willingness to pay threshold of £30,000 per QALY gained, and a high probability of cost effectiveness on the HADS-T measure.
  
  
  CONCLUSIONS
  The manual based coping intervention START, when added to treatment as usual, was cost effective compared with treatment as usual alone by reference to both outcome measures (affective symptoms for family carers, and carer based QALYs).
  
  
  BACKGROUND
  ISCTRN 70017938.
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, London WC2A 2AE, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: Derek
authors.initials: D
authors.lastname: King
authors.forename: Renee
authors.initials: R
authors.lastname: Romeo
authors.forename: Barbara
authors.initials: B
authors.lastname: Schehl
authors.forename: Julie
authors.initials: J
authors.lastname: Barber
authors.forename: Mark
authors.initials: M
authors.lastname: Griffin
authors.forename: Penny
authors.initials: P
authors.lastname: Rapaport
authors.forename: Debbie
authors.initials: D
authors.lastname: Livingston
authors.forename: Cath
authors.initials: C
authors.lastname: Mummery
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Walker
authors.forename: Juanita
authors.initials: J
authors.lastname: Hoe
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Sampson
authors.forename: Claudia
authors.initials: C
authors.lastname: Cooper
authors.forename: Gill
authors.initials: G
authors.lastname: Livingston
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D017028:Caregivers / Q000193:education / Q000523:psychology*; D003362:Cost-Benefit Analysis; D003704:Dementia; D003863:Depression / Q000175:diagnosis / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D057194:Intention to Treat Analysis; D016014:Linear Models; D008297:Male; D008370:Manuals as Topic; D008875:Middle Aged; D011581:Psychological Tests; D011613:Psychotherapy / Q000191:economics* / Q000379:methods; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom