TY - JOUR
T1 - Reducing loneliness to prevent depression in older adults in Australia
T2 - A modelled cost-effectiveness analysis
AU - Engel, Lidia
AU - Lee, Yong Yi
AU - Le, Long Khanh Dao
AU - Lal, Anita
AU - Mihalopoulos, Cathrine
N1 - Funding Information:
A previous study in the United Kingdom assessed the cost-effectiveness of an internet and computer training intervention in lonely older adults and the FEP in lonely older women ( Mallender et al., 2015 ). The study found that internet and computer training was cost-effective at £15,962 per quality-adjusted life year (QALY) gained, while the FEP was cost saving. However, the study did not model the cost-effectiveness of internet and computer training as part of a volunteer visiting program, which has been found to be more effective ( Fokkema & Knipscheer, 2007 ; Jones et al., 2015 ). It also remains unclear if such interventions represent good ‘value for money’ within the Australian context, alongside other implementation considerations. The aim of the current study was to evaluate the cost-effectiveness of the FEP and a volunteer-led internet and computer training (VICT) intervention in reducing loneliness and subsequent depression for older adults within the Australian context. The current study formed part of a larger program of work, funded by the National Mental Health Commission of Australia, which aimed to evaluate the return on investment credentials of ten preventive interventions for mental health across the life span ( Commission, 2020 ).
Funding Information:
This work was funded by the National Mental Health Commission (NMHC). The views expressed in this study are solely those of the authors and do not reflect the views of the NMHC.
Publisher Copyright:
© 2021
PY - 2021/12
Y1 - 2021/12
N2 - Purpose: The aim of the study was to evaluate the cost-effectiveness of the Friendship Enrichment Programme (FEP) and a volunteer-led internet and computer training (VICT) intervention to reduce loneliness in older adults and, in turn, prevent depression. Method: A population-based Markov model was developed to estimate the cost per quality-adjusted life year (QALY) gained and the return on investment (ROI) generated by investing in the interventions from a partial societal perspective. The model consisted of three health states (lonely, not lonely and dead). Costs, QALYs, and the subsequent impacts on depression associated with different health states were modelled. Both interventions were compared to a ‘no intervention’ scenario over a 5-year time horizon. Probabilitistic and deterministic sensitivity analyses were undertaken for both interventions. Results: The incremental cost-effectiveness ratio was dominant across both interventions, indicating that they were less costly and more effective when compared to the comparator. Results remained robust in the deterministic sensitivity analyses. However, probabilistic sensitivity analyses indicated high uncertainty, with only 55% and 68% of uncertainty iterations lying below the A$50,000 per QALY gained willingness-to-pay threshold for FEP and VICT, respectively. Both interventions generated cost savings that were greater than intervention costs, with a ROI of 2.87 for the FEP and 2.14 for the VICT intervention after 5 years. Conclusion: While FEP and VICT were found to be cost saving with positive returns on investment, the current evidence on intervention effectiveness is limited and needs to be strengthened before routine rollout can be recommended.
AB - Purpose: The aim of the study was to evaluate the cost-effectiveness of the Friendship Enrichment Programme (FEP) and a volunteer-led internet and computer training (VICT) intervention to reduce loneliness in older adults and, in turn, prevent depression. Method: A population-based Markov model was developed to estimate the cost per quality-adjusted life year (QALY) gained and the return on investment (ROI) generated by investing in the interventions from a partial societal perspective. The model consisted of three health states (lonely, not lonely and dead). Costs, QALYs, and the subsequent impacts on depression associated with different health states were modelled. Both interventions were compared to a ‘no intervention’ scenario over a 5-year time horizon. Probabilitistic and deterministic sensitivity analyses were undertaken for both interventions. Results: The incremental cost-effectiveness ratio was dominant across both interventions, indicating that they were less costly and more effective when compared to the comparator. Results remained robust in the deterministic sensitivity analyses. However, probabilistic sensitivity analyses indicated high uncertainty, with only 55% and 68% of uncertainty iterations lying below the A$50,000 per QALY gained willingness-to-pay threshold for FEP and VICT, respectively. Both interventions generated cost savings that were greater than intervention costs, with a ROI of 2.87 for the FEP and 2.14 for the VICT intervention after 5 years. Conclusion: While FEP and VICT were found to be cost saving with positive returns on investment, the current evidence on intervention effectiveness is limited and needs to be strengthened before routine rollout can be recommended.
KW - Depression
KW - Economic evaluation
KW - Loneliness
KW - Older adults
KW - Prevention
KW - Return on investment
UR - http://www.scopus.com/inward/record.url?scp=85115002935&partnerID=8YFLogxK
U2 - 10.1016/j.mhp.2021.200212
DO - 10.1016/j.mhp.2021.200212
M3 - Article
AN - SCOPUS:85115002935
SN - 2212-6570
VL - 24
JO - Mental Health & Prevention
JF - Mental Health & Prevention
M1 - 200212
ER -