Abstract
BackgroundDespite a growing understanding of the effectiveness of bereavement interventions and the groups that benefit most from them, we know little about the cost-effectiveness of bereavement interventions.MethodsWe conducted a cost-utility analysis alongside a randomized clinical trial on a visiting service for older widowed individuals (n = 110) versus care as usual (CAU; n = 106). The visiting service is a selective bereavement intervention that offers social support to lonely widows and widowers by a trained volunteer. Participants were contacted 6–9 months post-loss. Eleven percent of all contacted persons responded and eight percent participated in the trial. The primary outcome measure was quality adjusted life years (QALYs) gained (assessed with the EQ-5D), which is a generic measure of health status. Costs were calculated from a societal perspective excluding costs arising from productivity losses. Using the bootstrap method, we obtained the incremental cost utility ratio (ICUR), projected these on a cost-utility plane and presented as an acceptability curve.ResultsOverall, the experimental group demonstrated slightly better results against slightly higher costs. Whether the visiting service is acceptable depends on the willingness to pay: at a willingness to pay equal to zero per QALY gained, the visiting service has a probability of 31% of being acceptable; beyond €20,000, the visiting service has a probability of 70% of being more acceptable than CAU.ConclusionSelective bereavement interventions like the visiting service will not produce large benefits from the health economic point of view, when targeted towards the entire population of all widowed individuals. We recommend that in depth analyses are conducted to identify who benefits most from this kind of interventions, and in what subgroups the incremental cost-utility is best. In the future bereavement interventions are then best directed to these groups.Trial registrationControlled trials ISRCTN17508307
Highlights
Despite a growing understanding of the effectiveness of bereavement interventions and the groups that benefit most from them, we know little about the cost-effectiveness of bereavement interventions
The willingness to pay for a quality adjusted life years (QALYs) gained by preventive interventions is approximately €20,000, and at this threshold the visiting service has a probability of 70% of being more acceptable than care as usual (CAU)
Health related quality of life was measured with the EQ-5D which is a generic measure of health status
Summary
Despite a growing understanding of the effectiveness of bereavement interventions and the groups that benefit most from them, we know little about the cost-effectiveness of bereavement interventions. Types of intervention can vary from selfhelp groups to psychotherapy It appears that the effectiveness of a bereavement intervention is largely determined by the population towards it is directed. Most outreaching preventive interventions for all widowed individuals are not very beneficial [9], probably because most of the widowed are able to adjust relatively well over time and do not need a specific intervention to regain prebereavement levels of functioning. This does not apply to all widowed individuals. Interventions directed towards widows and widowers with a high risk profile, such as having more severe psychological problems or symptoms of complicated grief, do show desirable results [9]
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