Strategies for Relatives (START) intervention to improve the mental health of carers of people with dementia

Health Technology Wales
Record ID 32018001714
Original Title: Psychological interventions aimed at improving the mental health of carers of people with dementia
Authors' objectives: This report aims to identify and summarise evidence that addresses the following question: What is the clinical effectiveness and cost effectiveness of the Strategies for Relatives (START) intervention aimed at improving the mental health of carers of people with dementia?
Authors' results and conclusions: A series of studies that report on a UK-based trial of the START intervention were identified with differing findings across outcomes. In particular, START appears effective in reducing symptoms and cases of depression and improving the quality of life of carers compared with treatment as usual, but there was no difference in symptoms or cases of anxiety, quality of life for recipients of care, or time to placement in residential care. Follow-up of up to six years suggests that improvements can be maintained over time and that the intervention has long lasting impact. Recent meta-analyses on the effectiveness of similar interventions were also included and provide evidence that the findings of the START trial are plausible and reflective of findings with similar interventions. Economic evidence from the START trial suggests that, in the short term, this intervention is cost-effective if only carer costs are considered and cost-saving if the costs of both carer and recipient of care are included. As benefits have been shown to be maintained over longer follow-up, these findings may become more favourable over the long term.
Authors' recommendations: The evidence supports the routine adoption of the Strategies for Relatives (START) intervention for carers of people with dementia. The use of START leads to a reduction in symptoms of depression and an improvement in quality of life of the carer as compared to usual care. Benefits are evident in the short-term but are also maintained over a longer time-period. Health economic modelling suggests that START is cost-effective compared to usual care with an incremental cost-effectiveness ratio (ICER) of £12,400 per QALY and may lead to cost savings when benefits and cost for the recipients of care are also considered.
Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.
Project Status: Completed
Year Published: 2021
English language abstract: An English language summary is available
Publication Type: Rapid Review
Country: Wales, United Kingdom
MeSH Terms
  • Caregivers
  • Dementia
  • Psychotherapy
  • Family
  • Alzheimer Disease
  • Mental Health
  • Quality of Life
  • Dementia
  • Mental Health
  • Depression
  • Anxiety
  • Carers
  • Psychological Therapy
  • Psychotherapy
  • Psychoeducation
  • Cognitive Behavioural Therapy
  • Strategies for Relatives
  • Alzheimer's Disease
Organisation Name: Health Technology Wales
Contact Address: Floor 3, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ
Contact Name: Susan Myles, PhD
Contact Email:
Copyright: Health Technology Wales
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.