Table 5:
Economic analyses of interventions promoting mental health and well-being for older people
| Bibliographic information | Intervention (I) and comparator (C) | Target population and duration of economic analysis | Study design | Cost results | Mental health-related effectiveness results | Perspective/price year | Synthesis of costs and effectiveness data |
|---|---|---|---|---|---|---|---|
| Baumgarten et al. (2002), Canada | I: Adult day-care programme. Included personalized programme of therapeutic and preventive activities, developed after in-depth evaluation of specific needs and abilities. Objectives to reduce psychosocial problems, keep ability to perform activities of daily living, maintain nutrition and exercise | 280 patients older than 60 years of age, referred to any day centre | RCT | Mean cost of the services per client was CAD 2935 (±5536) in the intervention group and CAD 2138 (±4530) in the control group | Frequency of depression symptoms was measured using the Centre for Epidemiologic Studies Depression Scale (CES-D). There was a reduction in depression scores in both groups—16.9 to 16.5 in the intervention group, and 15.7 to 14.6 in the control group. No significant difference | Health, social and long-term care | No ratio reported as no significant difference in clinical outcomes or in costs. Intervention considered by authors as not shown to be cost-effective |
| C: Usual care (not described) | 3 months | CCA | These differences were not statistically significant | Anxiety scores on State-Trait Anxiety Scale went 39.7 to 39.2 in the intervention group, and 38.1 to 36.4 in the control group. No significant difference | 1991 CAD | ||
| No significant change in functional status or in caregiver burden between the two groups | |||||||
| (Bouman et al., 2008a, b), Netherlands | I: Eight home visits by home nurses with telephone follow-up. | 330 community-dwelling people aged 70–84 | RCT | Overall total cost per person, including the cost for the home visiting programme was €450 higher in the intervention group than in the control group. This difference was not statistically significant | Effectiveness analysis used a Self Rated Health Scale which looks at physical, mental and social functioning. No significant difference found in outcomes, but values not reported in paper | Health, social car and long-term care | No ratio reported as no significant difference in outcomes. On average intervention programme would have higher costs of €1525 but this was not statistically significant |
| C: Usual care | 24 months | CEA | Deemed to have only a 10% chance of being cost-effective | ||||
| (Charlesworth et al., 2008) and Wilson et al. (2009), England | I: Access to an employed befriending, facilitator and then offer of befriend in addition to usual care | 236 carers of people with dementia (PwD). Mean age of carers was 68 years (range 36–91 years) and the mean age of PwD was older at 78 years | RCT | Total intervention cost at 15 months £122, 665; control group £120, 852. This difference was not significant | Depression and anxiety measured using Hospital Anxiety and Depression Scale (HADS). Positive affect measured using Positive and Negative Affect Schedule. Loneliness using Loneliness Scale | Societal, public purse, voluntary sector and household | Incremental cost per incremental QALY gained of £105 494. In sensitivity analysis, only a 42.2% probability of being below threshold of £30 000 per QALY gained. |
| C: Usual care | 15 months | CUA | Incremental Quality of Life Years (QALY) gained using EQ-5D over 15 months of 0.017 QALYs (0.946 versus 0.929). This was not significant | Not found to be effective nor cost-effective | |||
| (Cohen et al., 2006), USA | I: Participation in choral singing group to promote mental and physical health | 166 English language-speaking healthy community-dwelling people aged >65 | RCT | Cost figures not stated but noted that significantly greater increase in doctor costs in the comparison group and lower increase in drug consumption in the intervention group | Philadelphia Geriatric Morale Scale; Geriatric Depression Scale Short Form; and engagement in social activities measured. Significantly lower decline in morale in the intervention group 14.15–14.08 versus 13.51–13.06 (p< 0.05). Significant reduction in loneliness 35.11–34.60 versus 38.26–37.02 (p< 0.1). No significant differences in depression, but significantly less decline in number of weekly activities in the intervention group 5.37–4.29 versus 4.88–2.58 (p< 0.01) | Health-care costs | No ratio but intervention dominant with better outcomes and lower costs than control group |
| C: No action | 12 months | Cost-offset analysis | |||||
| (Hay et al., 2002), USA | I: Weekly group activity sessions by occupational therapists to promote positive changes in lifestyle. Topics included health behaviours, transportation, personal safety, social relationships, cultural awareness and finances. | 163 ethnically diverse independent-healthy older people. | RCT | Programme costs $548 per person in OT group; $144 in social activity control group; $0 in passive control group. | Quality of life measured using the SF-36 and found to be statistically significantly in favour of OT group of 4.5% compared with combined controls (p< 0.001)—although actual QALY scores not reported in paper | Health and social care | Incremental cost per QALY gained with OT was $10 666 (95% CI: $6747–$25 430) over combined controls, $13 784 (95% CI: $7724–$57 879) over passive control group and $7820 (95% CI: $4993–$18025) over the social activity control |
| C: (i) Social activity control group who undertook activity sessions including craft, films, outings, games, dances; (ii) no-treatment control group (n= 59) | 9 months | CUA | Annual total costs (including health-care costs and healthcare costs to caregiver costs) were $4741in OT group, $3982 in social activity control group, $5388± passive control group and $4723 for combined control group). These differences were not statistically significant | 1995 USD | |||
| (Markle-Reid et al., 2006), Canada | I: Nursing health promotion services bolster personal resources and environmental supports in order to reduce the level of vulnerability, enhance health and quality of life | 288 people aged 75+ and newly referred to the Community Care Access Centre for personal support services | RCT | Costs figures not stated but noted no statistical difference in costs between groups | SF-36 used to measure physical and mental health. Center for Epidemiological Studies in Depression Scale—CES-D used to assess level of depression. There was a statistically significant average incremental improvement in SF-36 mental health score of 6.32 in the intervention group (10.8 versus 4.48) | Health and social care services | No ratio as costs not significantly different but better outcomes at same cost |
| C: Usual home care services | 6 months | CEA | Statistically significant reduction in mean depression symptom scores on CES-D score in intervention group of 2.72 (3.89 versus 1.17) | ||||
| (Munro et al., 2004), England | I: Invitation to participate in free exercise classes every 2 weeks | 20% least active older people in 12 primary care practices. 2283 in four practices were invited to exercise programme (of whom 590–26%—attended ≥1 session) and 4, 137 were controls | RCT | Mean costs €128 302/year, €125.78/session, €9.06/attender | Quality of life measured using the SF-36. Net significant QALY gains of 0.011 in the intervention group (p< 0.05) | Health-care payer perspective | Incremental cost per QALY gained of €17 174 |
| C: No invitation to participate | 24 months | CUA | The incremental annual cost of the programme was €253 700 per 10 000 participants | 2004. Euros, €s | |||
| (Onrust et al., 2008), Netherlands | I: Visiting service for older widow/ers bereaved for 6–9 months consisting of 10–12 home visits by a trained volunteer. Based on the Widow to Widow Programme | 138 widows/78 widowers; 110 in the intervention group; 106 in the control group; Mean age of participants 68.8 (range 50–92) | RCT | Annual costs of intervention €553 per participant. | Quality of life measured using EQ-5D. Statistically significant improvement in QALYs gained in visiting service group (0.03; p= 0.025) | Health service costs, non-health patient costs (travelling, car parking etc); impact on ability to perform domestic tasks | Incremental cost per QALY gained €6827. |
| Goal to bolster participant's personal resources through health assessment, managing risk factors and providing health education about lifestyles and disease management | 24 months | CUA | Annual mean overall costs of €3220 versus €2389 between intervention and control groups. However, difference in change in costs over time between two groups, €210, not significant | Intervention costs included time of volunteers 2003. Euros, €s |
Given a willingness to pay per QALY gained of €20 000; the intervention has a 70% of being cost-effective | ||
| C: Brief brochure on depressive symptoms in addition to usual home care: case management, personal care, home support, nursing, occupational therapy, physiotherapy, social work and speech language therapy through community-based agencies | |||||||
| (Pitkala et al., 2009), Finland | I: Psychosocial group rehabilitation for older people experiencing loneliness. Aim to empower, promote peer support and social integration | 235 community-dwelling older people (74 plus) experiencing loneliness | RCT | Costs associated with health-care utilization | Psychological well-being measured using a six-dimensional questionnaire. Psychological well-being score improved statistically significantly in the intervention groups +0.11 versus 0.01 (p< 0.05) | Health care | No ratio as intervention has better outcomes and lower health-care costs |
| C: No action | 12 months | COA | Significant net reduction in health-care costs of €943 per person per year (p< 0.05) | Euros, €s. Price year stated | |||
| (Van't Veer-Tazelaar, 2010), Netherlands | I: Stepped care intervention to prevent depression: watchful waiting, bibliotherapy, problem-solving treatment and antidepressant medication | 170 people; mean age 81.4; 70% women | RCT | Cost per patient of watchful waiting €26; bibliotherapy €259.25; problem-solving treatment €638.24; screening and referral to GP €59.36 | Depression assessed MINI/DSM–IV diagnostic status of depressive and anxiety disorders. Probability of depression/anxiety-free year was 0.88 in intervention group versus 0.76 in the control group (p< 0.05). | Societal | Incremental cost per depression/anxiety-free year gained was €4367. 94% probability of being cost-effective if willing to spend €20 000 per depression/anxiety-free year gained |
| C: Routine primary care | 12 months | CEA | Mean total costs in the intervention group €2985; control group €2453 | 2007 Euros, €s |
RCT, randomized controlled trial; CBA, cost–benefit analysis; CEA, cost-effectiveness analysis; CCA, cost-consequences analysis; CUA, cost–utility analysis; COA, cost-offset analysis.