JMIR Publications

ABSTRACT

Background:

Informal caregivers perform complex home-care tasks but often lack structured, task-specific training, causing preventable safety risks and added burden. Technology-enhanced simulation provides step-by-step practice; psychoeducational programs that flag risky activities may strengthen safety behaviors and self-efficacy. Despite scalability and just-in-time use, economic evidence remains sparse, especially for informal caregiving. Comparing costs and consequences is essential to guide efficient adoption

Objective:

To compare the cost–consequences of traditional caregiver education versus immersive digital simulation for home care, reporting disaggregated costs and outcomes (errors avoided, caregiver-burden reduction) to guide efficient, scalable adoption

Methods:

Secondary, pre-specified comparative synthesis of three coordinated parallel-group trials plus a contemporary control cohort, implemented under a shared core protocol in real-world Spanish settings (hospitals, primary care, community organizations). Eligibility, scenarios, and measures were prospectively harmonized. Design. Comparative cost–consequence assessment (CCA) with complementary incremental cost-effectiveness metrics versus control (ICERs in €/error avoided; €/burden point reduced). Four arms covered the same safety-critical scenarios: (1) psychoeducation; (2) virtual reality (VR); (3) augmented reality (AR, level 0); and (4) standard education. Outcomes: absolute change in 3-month self-reported errors and change in caregiver burden (ZBI-7, 0–28). Costing (societal perspective): costs in € per participant including staff time, caregiver time, and amortized development over 3 years at 200 participants/year. Downstream healthcare use was modelled by applying 1–5% (base 2%) of follow-up incidents to a composite unit cost of €1,257.03; combined costs equalled direct plus downstream, with no discounting (3-month horizon). Analysis: cost–consequence analysis (CCA) reporting costs with consequences in natural units; incremental comparisons versus control and pairwise cost-effectiveness comparisons also reported. ICERs were expressed as €/error avoided and €/ZBI-7 point reduced

Results:

A total of 282 caregivers were included (psychoeducational 71, VR 70, AR 71, control 70). Three-month incident changes: +31 control, −36 psychoeducational, −39 VR, −14 AR. Combined cost/participant (direct + 2% downstream): €46.88 control, €77.04 psychoeducational, €105.60 VR, €42.97 AR. Using per-participant effects, ICERs vs control were: errors avoided—€31.75/error psychoeducational, €58.72/error VR, and AR dominant (−€6.11/error; €3.91 saved/participant); burden (ZBI-7 total)—€55.85/point psychoeducational, €45.88/point VR, and AR dominant (−€6.41/point; €3.91 saved/participant). Pairwise for burden: VR vs psychoeducational €38.59 per extra point; AR vs psychoeducational dominant; VR vs AR €93.48 per extra point

Conclusions:

Technology-enhanced caregiver training can deliver meaningful safety gains at low unit cost. Findings support a stepped strategy: deploy AR as a scalable default, add VR selectively for higher-risk tasks or caregivers with elevated burden, and use psychoeducation to extend low-cost error reduction when resources are constrained and time for in-person training is limited. This approach aligns safety improvement with pragmatic budget impact for real-world home-care programs. Clinical Trial: NCT05247801; registered January 21, 2022; and NCT05885334; registered March 31, 2023