A Review of Dementia Caregiver Interventions: Valuing Psychological Well-Being and Economic Impact Through the State-Preference Method

TL;DR

This paper reviews dementia caregiver interventions, focusing on their psychological and economic impacts using stated-preference methods.

Contribution

It integrates clinical and economic evidence with stated preference measures to assess the value of non-pharmacological interventions for dementia caregivers.

Findings

Psychoeducational programs and cognitive rehabilitation consistently reduce caregiver distress and improve quality of life.

TAP interventions show favorable cost-effectiveness by reducing caregiver burden and patient behavioral problems.

Online modules with telephone support improve psychological outcomes, though results for technological solutions are mixed.

Abstract

Public health relevance—How does this work relate to a public health issue?
Caregiver-focused psychological interventions reduce distress and burden; economic evidence is growing but often methodologically heterogeneous.

Caregiver-focused psychological interventions reduce distress and burden; economic evidence is growing but often methodologically heterogeneous.

Public health significance—Why is this work of significance to public health?
A PRISMA-based synthesis linking clinical outcomes with costs and stated-preference evidence (WTP/WTA), showing robust value signals for START and TAP, mixed utility gains for online CBT, and limited effects for ATT.

A PRISMA-based synthesis linking clinical outcomes with costs and stated-preference evidence (WTP/WTA), showing robust value signals for START and TAP, mixed utility gains for online CBT, and limited effects for ATT.

Public health implications—What are the key implications or messages for practitioners, policymakers and/or researchers in public health?
Standardizing utility measurement and WTP/WTA elicitation—and adopting societal perspectives that include informal care—will strengthen value assessments and guide scalable caregiver support policies.

Standardizing utility measurement and WTP/WTA elicitation—and adopting societal perspectives that include informal care—will strengthen value assessments and guide scalable caregiver support policies.

Objectives. To integrate clinical and economic evidence on the main non-pharmacological interventions aimed to reduce the burden of caregivers of people with dementia, with specific attention to stated preference measures (SPM), Willingness-to-Pay (WTP) and Willingness-to-Accept (WTA), alongside other cost-effectiveness indicators (ICER, QALY). Methods. A systematic review was conducted on randomized and quasi-experimental evaluations, economic models, and preference studies concerning psychoeducational/coping interventions, activity-centered/occupational programs (TAP), technological solutions and tele-support, and goal-oriented cognitive rehabilitation (CR). For each study, the following indexes were extracted: design, sample size, psychological outcomes (anxiety/depression, burden, engagement), utility per QALY, costs per perspective (the health–social and the broader societal perspectives), ICER, WTP/WTA, and sensitivity results. Results. Psychoeducational programs and CR show consistent benefits on distress, anxiety/depression, and caregiver quality of life; TAP reduces caregiver burden and patient behavioral problems, with favorable signs of cost–effectiveness; results on the effects of technologies are heterogeneous, but online modules with telephone support improve psychological morbidity. QALY improvement is generally modest, but the probability of cost-effectiveness remains high when costs do not differ significantly from treatment as usual, or when, from a societal perspective, the unpaid caregiving time of the caregiver is valued. Preference studies indicate positive WTP for additional hours of home care, health–social integration, and facilitated groups; evidence on WTA is scarcer and methodologically variable. Conclusions. Short, structured interventions with a human support component offer good value-for-money; the adoption of societal perspectives and the systematic use of WTP/WTA can better capture the value perceived by caregivers. Heterogeneity issues persist.

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