Cost-effectiveness of an online intervention for caregivers of people living with dementia

Henderson, Catherine, Knapp, Martin ORCID: 0000-0003-1427-0215, Fossey, Jane, Frangou, Elena and Ballard, Clive (2022) Cost-effectiveness of an online intervention for caregivers of people living with dementia. Journal of the American Medical Directors Association, 23 (9). 1468 - 1473. ISSN 1525-8610

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Abstract

Objectives Little evidence exists on costs or cost-effectiveness of online interventions for caregivers of people living with dementia. We aimed to assess cost-effectiveness of online cognitive behavioral therapy (CBT) for dementia caregivers with mild-to-moderate depression/anxiety, with or without telephone support, relative to a psychoeducational control treatment. Design Cost-effectiveness study of data from 3-armed randomized controlled trial comparing computerized CBT (cCBT) or telephone-supported cCBT (cCBT+Telephone) to modular online educational program on dementia (Psychoeducation). Setting and Participants UK-resident adult dementia caregivers with mild-to-moderate anxiety/depression. Cost-effectiveness analysis We calculated health and social care costs, from participant-reported data collected at baseline, 12, 26 weeks, costs of intervention delivery. We examined 3 outcomes: cost of one-point reduction in General Health Questionnaire–12 (GHQ-12) rating at 26-weeks, cost of prevented “caseness” on GHQ-12 at 26 weeks, and cost per quality-adjusted life year (QALY) based on Short Form–6 Dimensions (SF-6D) over 26 weeks. Results Data from 176 participants (44 cCBT, 91 cCBT+Telephone, 41 Psychoeducation) were analyzed. Costs did not differ between cCBT and Psychoeducation; costs were £125 higher in cCBT+Telephone. Control and intervention groups did not differ on GHQ-12. Caseness was lower in cCBT+Telephone than Psychoeducation; cost of preventing a case was £610, and probability of cost-effectiveness on this outcome reached 98.5% at willingness to pay (WTP) of £12,900. Mean QALY did not differ between cCBT+Telephone and Psychoeducation. QALY gain in cCBT was 0.01 (95% CI 0.001, 0.021). Cost per QALY was £8130. Although base case probability of cost-effectiveness of cCBT was 93% at WTP-per-QALY of £27,600, sensitivity analyses suggested cCBT+Telephone was the more cost-effective. Conclusions and Implications We report preliminary evidence for adopting telephone-supported online CBT. This may be cost-effective in preventing a case of mental health disorder if, absent a societally accepted WTP threshold for this outcome, payers are willing to pay £12,900. Future research should investigate whether supported/unsupported online CBT improves health-related quality of life.

Item Type:	Article
Official URL:	https://www.jamda.com/
Additional Information:	© 2022 The Authors
Divisions:	Personal Social Services Research Unit Health Policy
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RM Therapeutics. Pharmacology
Date Deposited:	05 May 2022 16:06
Last Modified:	23 Apr 2024 09:49
URI:	http://eprints.lse.ac.uk/id/eprint/115045

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