Authors' objectives:

"The aims of this trial were two-fold. First, to determine whether a social support intervention (access to an employed befriending facilitator in addition to usual care) is effective compared with usual care alone, through randomly allocating carers of people with dementia to one of two groups (intervention versus usual care control) and follow-up for 2 years postrandomisation. Secondly, to document direct and indirect costs in both the intervention and control group, and establish incremental cost-effectiveness, calculating the costs from the perspectives of the statutory and voluntary sectors and from a societal perspective." (from executive summary)

Authors' results and conclusions: Of 316 people expressing interest in participating, 236 (75%) were randomised into the trial (116 intervention; 120 control). At final follow-up (24 months postrandomisation) 190 carers (93 intervention; 97 control) were still involved in the trial (19% attrition). There was no evidence of effectiveness or cost-effectiveness from the primary analyses on the intention-to-treat population. The mean incremental cost per incremental QALY gained was in excess of GBP100,000, with only a 42.2% probability of being below GBP30,000 per QALY gained. Analyses on secondary outcomes were similarly negative, and there was no evidence of cost-effectiveness in the alternative scenarios considered except where care-recipient QALYs were included. In this case mean incremental cost per incremental QALY gained was GBP26,848, with a 51.4% probability of being below GBP30,000 per QALY gained. Only 60 carers (52%) took up the offer of being matched with a trained lay befriender, and of these only 37 (32%) were befriended for 6 months or more. A subgroup analysis of controls versus those befriended for 6 months or more found a reduction in HADS-depression scores that approached statistical significance (95% CI ;0.09 to 2.84).

Authors' recommendations: Conclusions 'Access to a befriender facilitator' is neither an effective nor a cost-effective intervention in the support of carers of people with dementia, although there is a suggestion of cost-effectiveness for the care dyad (carer and care recipient). In common with many services for carers of people with dementia, uptake of befriending services was not high. However, the small number of carers who engaged with befrienders for 6 months or more reported a reduction in scores on HADS depression that approached statistical significance compared with controls (95% CI ;0.09 to 2.84). While providing only weak evidence of any beneficial effect, further research into befriending interventions for carers is warranted. Implications for healthcare Volunteers can be safely involved in the provision of emotional support for carers. When considering commissioning support services for carers of people with dementia, befriending schemes alone should not be commissioned, and short-term contracts should not be considered. Recommendations for further research Additional research is required to establish: the characteristics of carers most likely to take up befriending; befriender;carer characteristics of successful matches; interplay between statutory and voluntary support services and support from families; carer well-being in the context of receipt of befriending; and placement of the care recipient in long-term residential or nursing care. Future cost-effectiveness evaluations of carer support should include outcomes for both the carer and care recipient. Further work is required on economic methods for carer intervention research.

Authors' methods: Randomised controlled trial

Project Status: Completed

URL for project: http://www.hta.ac.uk/1233

Year Published: 2008

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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