Cost-effectiveness of a befriending intervention to improve the wellbeing and reduce loneliness of older women

Abstract

BackgroundGood mental wellbeing is important throughout the life course, including in older ages. This study aimed to assess the cost-effectiveness of friendship programmes to improve wellbeing and reduce loneliness of older people. MethodsA descriptive cost-consequence analysis and a cost-utility analysis were used to assess the cost-effectiveness of a friendship enrichment programme for older women (53–86 years) comprising 12 lessons that focused on friendship-related topics such as self-esteem (n=60), versus no intervention (waiting list [control], n=55). The analysis drew on an original study of the intervention, which analysed participants at baseline, after the intervention, or 3 months after baseline, and 9–10 months after baseline. The cost-consequence analysis reported outcomes covering elements of friendships, self-esteem, loneliness, and subjective wellbeing. The cost-utility analysis used a decision analytical model, and was populated with published data on the effect of loneliness on health outcomes, including depression, stroke, and coronary heart disease; it adopted a lifetime horizon and health service perspective. FindingsAfter 9–10 months, the intervention generated statistically significant improvements in mean scores for negative affect (Positive and Negative Affect Scale 28·14 [SD 5·10] vs 29·46 [5·37], p=0·027), self-esteem (assertiveness scale [Brinkman] 34·56 [6·35] vs 32·31 [7·77], p=0·001), life satisfaction (Satisfaction with Life Scale 15·19 [3·93] vs 14·08 [4·19], p=0·012), and loneliness (De Jong, Gierveld, and Van Tilburg loneliness scale 6·63 [3·59] vs 7·49 [3·52], p=0·041). For loneliness, the mean declines in loneliness in the intervention and control groups were not significantly different (ANOVA 0·86 vs 0·25, p=0·51). On the basis of an evidence review linking this reduction in loneliness (calculated at 3% over the control group) with health benefits, the friendship programme is expected to reduce depression by 1·04%, reduce the early onset of dementia by 0·21%, and increase physical activity by 1·93% (thus reducing diabetes by 0·13%, stroke by 0·15%, and coronary heart disease by 0·27%). Against an intervention cost of £120, discounted future cost savings to the health service were estimated to be £391 and quality-adjusted life-years gained of 0·035 per person. InterpretationThe intervention is both effective and cost-saving, suggesting that friendship programmes help enhance both the health and wellbeing of older women and are a good use of public money. This finding is important because the growing number of older people in the UK raises serious concerns about the demand for health and social care services. FundingNational Institute for Health and Care Excellence (NICE).