Teuni H Rooijackers1,2, Silke F Metzelthin1,2, Erik van Rossum1,2,3, Gertrudis I J M Kempen1,2, Silvia M A A Evers1, Andrea Gabrio4, G A Rixt Zijlstra1. 1. Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands. 2. Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands. 3. Research Center for Community Care, Academy of Nursing, Zuyd University of Applied Sciences, Heerlen, the Netherlands. 4. Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
Abstract
PURPOSE: Training and supporting homecare staff in reablement aims to change staff behavior from "doing for" to "doing with" older adults and is assumed to benefit the health and quality of life of older adults and reduce healthcare utilization and costs. This study evaluated the cost-effectiveness and cost-utility of the staff reablement training program "Stay Active at Home" (SAaH) from a societal perspective. PARTICIPANTS AND METHODS: An economic evaluation was embedded in a 12-month cluster randomized controlled trial. Ten Dutch homecare nursing teams participated (n = 313 staff members), of which five teams were trained in reablement and the other five provided usual care. Cost and effect data were collected from 264 older adults at baseline, 6 and 12 months. Costs included "intervention," "healthcare," and "patient and family" costs (collectively, societal costs) and were assessed using questionnaires and client records or estimated by bottom-up micro-costing. Effects included sedentary behavior and quality-adjusted life years (QALYs). Multiple imputed bootstrapped data were used to generate cost-effectiveness planes and acceptability curves. RESULTS: No statistically significant differences were observed between the intervention and control group in terms of sedentary time (adjusted mean difference: 4.8 minutes [95% CI -26.4, 36.0]), QALYs ( 0.01 [95% CI -0.03, 0.04]), and societal costs ( €2216 [95% CI -459, 4895]), except lower costs for domestic help in the intervention group ( €-173 [95% CI -299, -50]). The probability that SAaH was cost-effective compared to usual care ranged from 7.1% to 19.9%, depending on the willingness-to-pay (WTP) (€0‒€50,000)/minute of sedentary time averted and was 5.9% at a WTP of €20,000/QALY gained. CONCLUSION: SAaH did not improve outcomes or reduce costs and was not cost-effective from a societal perspective compared to usual care in Dutch older adults receiving homecare. Consequently, there is insufficient evidence to justify widespread implementation of the training program in its current form. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03293303.
PURPOSE: Training and supporting homecare staff in reablement aims to change staff behavior from "doing for" to "doing with" older adults and is assumed to benefit the health and quality of life of older adults and reduce healthcare utilization and costs. This study evaluated the cost-effectiveness and cost-utility of the staff reablement training program "Stay Active at Home" (SAaH) from a societal perspective. PARTICIPANTS AND METHODS: An economic evaluation was embedded in a 12-month cluster randomized controlled trial. Ten Dutch homecare nursing teams participated (n = 313 staff members), of which five teams were trained in reablement and the other five provided usual care. Cost and effect data were collected from 264 older adults at baseline, 6 and 12 months. Costs included "intervention," "healthcare," and "patient and family" costs (collectively, societal costs) and were assessed using questionnaires and client records or estimated by bottom-up micro-costing. Effects included sedentary behavior and quality-adjusted life years (QALYs). Multiple imputed bootstrapped data were used to generate cost-effectiveness planes and acceptability curves. RESULTS: No statistically significant differences were observed between the intervention and control group in terms of sedentary time (adjusted mean difference: 4.8 minutes [95% CI -26.4, 36.0]), QALYs ( 0.01 [95% CI -0.03, 0.04]), and societal costs ( €2216 [95% CI -459, 4895]), except lower costs for domestic help in the intervention group ( €-173 [95% CI -299, -50]). The probability that SAaH was cost-effective compared to usual care ranged from 7.1% to 19.9%, depending on the willingness-to-pay (WTP) (€0‒€50,000)/minute of sedentary time averted and was 5.9% at a WTP of €20,000/QALY gained. CONCLUSION: SAaH did not improve outcomes or reduce costs and was not cost-effective from a societal perspective compared to usual care in Dutch older adults receiving homecare. Consequently, there is insufficient evidence to justify widespread implementation of the training program in its current form. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03293303.
Authors: Andy Cochrane; Mairead Furlong; Sinead McGilloway; David W Molloy; Michael Stevenson; Michael Donnelly Journal: Cochrane Database Syst Rev Date: 2016-10-11
Authors: Adeela Usman; Sarah Lewis; Kathryn Hinsliff-Smith; Annabelle Long; Gemma Housley; Jake Jordan; Heather Gage; Tom Dening; John R F Gladman; Adam L Gordon Journal: BMJ Open Date: 2018-08-17 Impact factor: 2.692
Authors: Teuni H Rooijackers; G A Rixt Zijlstra; Erik van Rossum; Ruth G M Vogel; Marja Y Veenstra; Gertrudis I J M Kempen; Silke F Metzelthin Journal: BMC Geriatr Date: 2021-01-06 Impact factor: 3.921