Cost-Effectiveness of an Online Intervention for Caregivers of People Living With Dementia

摘要

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 pound 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 (sic)610, and probability of cost-effectiveness on this outcome reached 98.5 at willingness to pay (WTP) of (sic)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 (sic)8130. Although base case probability of cost-effectiveness of cCBT was 93 at WTP-per-QALY of (sic)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 (sic)12,900. Future research should investigate whether supported/unsupported online CBT improves health-related quality of life. (C) 2022 The Authors. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.