Impact of Cognitive Behavioral Therapy on Health Care Expenditures among African-American Dementia Caregivers with Depression

Alzheimer's disease (AD) and related dementias have substantial detrimental effects on the health and quality of life of older adults and their caregivers. The Alzheimer's Caregiver Training and Support (ACTS) is a pilot study aimed at comparing the cost and effectiveness of face-to-face and telephone-based Cognitive Behavioral Therapy (CBT) interventions on depression and health status among a group of African-American dementia caregivers in Northeast Florida. We used data collected by blinded interviews at baseline (pre) and one week after the 12-week CBT intervention (post). The Health Service Composite (HSC), a validated instrument was used to collect information regarding health services utilization (medical, mental health, emergency room, hospitalization), and out-of-pocket health-related expenditures. Average prices for each type of health services were obtained from the Medical Expenditure Panel Survey (MEPS). The sample consists of 109 individuals (53 in the face-to-face group and 56 in the telephone group). During the 3 months prior to program enrollment, 78.8% of the sample had at least one physician office visit, 84.6% had at least one prescription medication, 9.6% had at least one overnight stay in a hospital, and 11.5% had visited the ER. Multivariate regression analysis found that while telephone-based intervention was associated with an average of $138 lower monthly health care expenditures, the difference between telephone and face-to-face interventions did not reach statistical significance (p=0.70). The findings suggest that the telephone-based CBT is potentially a cost-effective intervention approach to improve health outcomes among African American dementia caregivers.