Cost-utility analysis of an internet and computer training intervention to improve independence and mental wellbeing of older people

Abstract

BackgroundGood mental health and emotional wellbeing are as important in older age as at any other time of life. This study aimed to assess the cost-effectiveness of an intervention to improve the independence and mental wellbeing of older people. MethodsCost-consequence analysis (CCA) and cost-utility analysis (CUA) were used to assess the cost-effectiveness of an internet and computer training intervention (9 h of group training over 2 weeks) versus no training. The CCA reported a range of outcomes, including reductions in loneliness and social isolation. The CUA was conducted with a decision analytical model, and populated with published data on the effect of loneliness on health outcomes such as depression, stroke, and coronary heart disease; it adopted a lifetime horizon and health service perspective. FindingsThe original intervention study (appendix) identified no statistically significant difference between groups for loneliness after 5 months, but noted increased computer use. Increased computer use has been linked to a range of positive outcomes more generally, including social network benefits and a decrease in isolation and loneliness, and this was outlined in the CCA. The increase in computer use identified in the original study corresponded to a 1·62 decrease in loneliness (UCLA Loneliness Scale), which resulted in about 2% of the population moving from moderately lonely to not lonely. Focusing only on the health outcomes that are improved by a reduction in loneliness, the internet and computer training intervention is expected to reduce depression by 0·67%, reduce the early onset of dementia by 0·14%, and increase physical activity by 1·24% (thus reducing diabetes by 0·09%, stroke by 0·1%, and coronary heart disease by 0·17%). An intervention cost of £564 per person leads to future cost savings to the health service of £224 and a quality adjusted life years gain of 0·021 per person (all present values). The incremental cost-effectiveness ratio is £15 962 (ranging from £2735 to £42 415 in the sensitivity analysis, appendix). This excludes benefits in terms of reduced mortality, as well as other gains discussed in the CCA, such as social network benefits. InterpretationAlthough this analysis was based on extrapolation from an initial study with a fairly short follow-up, the results suggest that an internet and computer training intervention is likely to be cost effective at improving the physical and mental health of older people. FundingNational Institute for Health and Care Excellence (NICE).