"… we in the United States are so averse to the idea of cost effectiveness that when the Patient Centered Outcomes Research Institute, the body specifically set up to do comparative effectiveness research, was founded, the law explicitly prohibited it from funding any cost-effectiveness research at all.
Amid all the noise about health care, the idea of comparative effectiveness studies - that is the direct comparison of two or more strategies - was framed as an effort to reduce cost.
In order to get an idea of the effectiveness of STW in these different scenarios, the cumulative difference in average hours worked with and without STW during the downturn is interpreted as a measure of the use of STW (up to t = 1 in the first scenario and t + 4 in the other two scenarios).
Comparison of health-care visits gives only a limited idea of cost effectiveness.
It appears that the difficulties with managed care experienced by the United States during the 1990s have prompted a rapid movement away from this form, without a clear idea of the effectiveness of consumer driven care, or other alternatives.
The idea of the effectiveness of an early beginning of intervention is theoretically underpinned by the concept of a sensitive period of fast neuropsychological growth, and the influence of early social-emotional experiences, respectively attachment regulation processes as well as the ability to cope with stress.
However, systematic reviews [ 10, 11] and meta analysis [ 30] which have included non-randomised studies suggest, as we do, that there is little evidence to support the idea of universal effectiveness of interventions to improve the lives of caregivers of people with dementia.
