Clinical effectiveness of the START (STrAtegies for RelaTives) psychological intervention for family carers and the effects on the cost of care for people with dementia: 6-year follow-up of a randomised controlled trial

TY - JOUR

T1 - Clinical effectiveness of the START (STrAtegies for RelaTives) psychological intervention for family carers and the effects on the cost of care for people with dementia

T2 - 6-year follow-up of a randomised controlled trial

AU - Livingston, Gill

AU - Manela, Monica

AU - O'Keeffe, Aidan

AU - Rapaport, Penny

AU - Cooper, Claudia

AU - Knapp, Martin

AU - King, Derek

AU - Romeo, Renee

AU - Walker, Zuzana

AU - Hoe, Juanita

AU - Mummery, Cath

AU - Barber, Julie

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background The START (STrAtegies for RelaTives) intervention reduced depressive and anxiety symptoms of family carers of relatives with dementia at home over 2 years and was cost-effective.Aims To assess the clinical effectiveness over 6 years and the impact on costs and care home admission.Method We conducted a randomised, parallel group, superiority trial recruiting from 4 November 2009 to 8 June 2011 with 6-year follow-up (trial registration: ISCTRN 70017938). A total of 260 self-identified family carers of people with dementia were randomised 2:1 to START, an eight-session manual-based coping intervention delivered by supervised psychology graduates, or to treatment as usual (TAU). The primary outcome was affective symptoms (Hospital Anxiety and Depression Scale, total score (HADS-T)). Secondary outcomes included patient and carer service costs and care home admission.Results In total, 222 (85.4%) of 173 carers randomised to START and 87 to TAU were included in the 6-year clinical efficacy analysis. Over 72 months, compared with TAU, the intervention group had improved scores on HADS-T (adjusted mean difference-2.00 points, 95% CI-3.38 to-0.63). Patient-related costs (START versus TAU, respectively: median £5759 v. £16 964 in the final year; P = 0.07) and carer-related costs (median £377 v. £274 in the final year) were not significantly different between groups nor were group differences in time until care home (intensity ratio START:TAU was 0.88, 95% CI 0.58-1.35).Conclusions START is clinically effective and this effect lasts for 6 years without increasing costs. This is the first intervention with such a long-term clinical and possible economic benefit and has potential to make a difference to individual carers.

AB - Background The START (STrAtegies for RelaTives) intervention reduced depressive and anxiety symptoms of family carers of relatives with dementia at home over 2 years and was cost-effective.Aims To assess the clinical effectiveness over 6 years and the impact on costs and care home admission.Method We conducted a randomised, parallel group, superiority trial recruiting from 4 November 2009 to 8 June 2011 with 6-year follow-up (trial registration: ISCTRN 70017938). A total of 260 self-identified family carers of people with dementia were randomised 2:1 to START, an eight-session manual-based coping intervention delivered by supervised psychology graduates, or to treatment as usual (TAU). The primary outcome was affective symptoms (Hospital Anxiety and Depression Scale, total score (HADS-T)). Secondary outcomes included patient and carer service costs and care home admission.Results In total, 222 (85.4%) of 173 carers randomised to START and 87 to TAU were included in the 6-year clinical efficacy analysis. Over 72 months, compared with TAU, the intervention group had improved scores on HADS-T (adjusted mean difference-2.00 points, 95% CI-3.38 to-0.63). Patient-related costs (START versus TAU, respectively: median £5759 v. £16 964 in the final year; P = 0.07) and carer-related costs (median £377 v. £274 in the final year) were not significantly different between groups nor were group differences in time until care home (intensity ratio START:TAU was 0.88, 95% CI 0.58-1.35).Conclusions START is clinically effective and this effect lasts for 6 years without increasing costs. This is the first intervention with such a long-term clinical and possible economic benefit and has potential to make a difference to individual carers.

KW - cost

KW - dementia

KW - depression

KW - Family carer

KW - randomised controlled trial

UR - http://www.scopus.com/inward/record.url?scp=85074865587&partnerID=8YFLogxK

U2 - 10.1192/bjp.2019.160

DO - 10.1192/bjp.2019.160

M3 - Article

C2 - 31298169

AN - SCOPUS:85074865587

SN - 0007-1250

VL - 216

SP - 35

EP - 42

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

IS - 1

ER -