Befriending carers of people with dementia: a cost utility analysis

• Published in: International journal of geriatric psychiatry 2009-06, Vol.24 (6), p.610-623
• Main Authors: Wilson, Edward, Thalanany, Mariamma, Shepstone, Lee, Charlesworth, Georgina, Poland, Fiona, Harvey, Ian, Price, David, Reynolds, Shirley, Mugford, Miranda
• Format: Article
• Language: English
• Subjects: befriending; Biological and medical sciences; Caregivers; Caregivers - economics; Caregivers - psychology; Clinical trials; cost effectiveness; cost utility; Costs and Cost Analysis; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dementia; Dementia - economics; Dementia - psychology; economics; Effectiveness; family caregivers; Female; Geriatric psychiatry; Geriatrics; Health Services for the Aged - economics; Health Services for the Aged - utilization; Home Care Services - economics; Home Care Services - utilization; Humans; Male; Medical sciences; Miscellaneous; Neurology; Outcome Assessment (Health Care) - economics; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life; Quality-Adjusted Life Years; Sensitivity analysis; Single-Blind Method; Social Support; United Kingdom
• ISSN: 0885-6230; 1099-1166
• DOI: 10.1002/gps.2164

Objective There is very little evidence on the cost‐effectiveness of social care interventions for people with dementia or their carers. The BEfriending and Costs of CAring trial (BECCA, ISRCTN08130075) aimed to establish whether a structured befriending service improved the quality of life of carers of people with dementia, and at what cost. Methods We performed an economic evaluation alongside a single blind, randomised controlled trial in a community setting of 236 carers of people with a primary progressive dementia. The intervention was contact with a Befriender Facilitator (BF), and offer of match with a trained lay volunteer befriender compared with no BF contact. Main outcome measures were health and social care, voluntary sector, and family care costs and quality adjusted life years (QALYs) in carers over 15 months. Results Mean QALYs per carer over 15 months were 0.017 higher in the intervention group compared with control (95%CI: −0.051, 0.083). Mean costs from a societal perspective were £1,813 higher (−£11,312, £14,984). The point estimate Incremental Cost Effectiveness Ratio (ICER) is thus £105,954 per incremental QALY gained. Probabilistic sensitivity analysis suggests a 42.2% probability that the ICER is below £30,000 per QALY. Inclusion of dementia patient QALYs reduces the ICER to £28,848 (51.4% probability below £30,000). Conclusions Befriending leads to a non‐significant trend towards improved carer quality of life, and there is a non‐significant trend towards higher costs for all sectors. It is unlikely that befriending is a cost‐effective intervention from the point of view of society. Copyright © 2008 John Wiley & Sons, Ltd.