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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. ISSN 1525-8610

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Identification Number: 10.1016/j.jamda.2022.03.002

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 Funding Information: This work was supported by the Alzheimer's Society , grant number 434 . Funding Information: Declaration of interests. CH and MK report grants from the Alzheimer's Society outside the submitted work. JF received support from the NIHR Oxford Health Biomedical Research Centre , a partnership between Oxford Health NHS Foundation Trust and the University of Oxford, and acknowledges the support of the National Institute for Health Research (NIHR) Senior Nurse and Midwife Research Leader Programme , NIHR Oxford Cognitive Health Clinical Research Facility and the Oxford Institute for Nursing, Midwifery and Allied Health Research (OxINMAHR). EF declares no interests. CB reports grants and personal fees from Acadia Pharmaceutical Company and Lundbeck ; and personal fees from Roche, Otsuka, Novartis, Eli Lilly, Suven, Sunovion, ADDEX, and Exciva; personal fees and other from Synexus and Novo Nordisk; and other from Biogen, outside the submitted work. Funding Information: This work was supported by the Alzheimer's Society, grant number 434.Declaration of interests. CH and MK report grants from the Alzheimer's Society outside the submitted work. JF received support from the NIHR Oxford Health Biomedical Research Centre, a partnership between Oxford Health NHS Foundation Trust and the University of Oxford, and acknowledges the support of the National Institute for Health Research (NIHR) Senior Nurse and Midwife Research Leader Programme, NIHR Oxford Cognitive Health Clinical Research Facility and the Oxford Institute for Nursing, Midwifery and Allied Health Research (OxINMAHR). EF declares no interests. CB reports grants and personal fees from Acadia Pharmaceutical Company and Lundbeck; and personal fees from Roche, Otsuka, Novartis, Eli Lilly, Suven, Sunovion, ADDEX, and Exciva; personal fees and other from Synexus and Novo Nordisk; and other from Biogen, outside the submitted work.We thank the Alzheimer's Society for funding the economic evaluation. We also thank those involved in organizing the CFMAY trial: Georgina Charlesworth, Jo-Ann Fowler, Theo John Pimm, June Dent, Joanne Ryder, Amanda Robinson, Robert Kahn, Dag Aarsland, James Pickett, and Clive Ballard. We are grateful to the caregivers who participated in the study. Publisher Copyright: © 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine
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: 14 Jun 2022 10:00
URI: http://eprints.lse.ac.uk/id/eprint/115045

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