Cost-utility of behavioural activation for mitigating psychological impacts of COVID-19 on socially isolated older adults with depression and multiple long-term conditions compared with usual care: results from a pragmatic randomised controlled trial
Background Depression alongside multiple long-term conditions (MLTCs) in older adults poses a critical public health challenge, worsening physical and mental health and increasing healthcare costs. COVID-19 restrictions further exacerbated these impacts. Behavioural activation (BA) shows promise as...
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| Format: | Article |
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Mental Health |
| Online Access: | https://mentalhealth.bmj.com/content/28/1/e301270.full |
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| author | Simon Gilbody Caroline Fairhurst Catherine Hewitt Dean McMillan Carolyn Chew-Graham Della Bailey David Ekers Steve Parrott Elizabeth Littlewood Peter Coventry Han-I Wang Kalpita Baird |
| author_facet | Simon Gilbody Caroline Fairhurst Catherine Hewitt Dean McMillan Carolyn Chew-Graham Della Bailey David Ekers Steve Parrott Elizabeth Littlewood Peter Coventry Han-I Wang Kalpita Baird |
| author_sort | Simon Gilbody |
| collection | DOAJ |
| description | Background Depression alongside multiple long-term conditions (MLTCs) in older adults poses a critical public health challenge, worsening physical and mental health and increasing healthcare costs. COVID-19 restrictions further exacerbated these impacts. Behavioural activation (BA) shows promise as a remote intervention for depression during isolation, but its cost-effectiveness for depressed, socially isolated older adults remains uncertain.Objective This study aimed to assess the cost-utility of BA versus usual care for older adults with depression and MLTCs during COVID-19 restrictions.Methods A randomised controlled trial recruited and randomised individuals aged 65 and over with depressive symptoms and MLTC (n=435) to either the BA intervention or usual care. Costs were measured from the perspective of the National Health Service and personal social services. Quality-adjusted life years (QALYs) were measured using the EQ-5D-3L at baseline, and 1, 3 and 12 months postrandomisation. Incremental cost-effectiveness ratios were calculated, with uncertainty addressed through non-parametric bootstrapping. Sensitivity analyses were conducted to assess the robustness of the primary analysis.Findings Primary analysis indicated that BA generated a small cost-saving (£62.34 per older adult; 95% CI: −£120.44 to £239.70) while QALY improvements remained unchanged (0.007; 95% CI −0.036 to 0.022) compared with usual care. The probability of BA being the preferred option is 0.71. Sensitivity analyses supported the primary analysis findings, confirming their robustness.Conclusions and clinical implications Compared with usual care, BA demonstrated a slight cost reduction while maintaining QALY improvement. The findings provide promise for BA interventions for older people with depression and MLTCs facing isolation. |
| format | Article |
| id | doaj-art-d81d1426eb40481eaa90bb477dd7bdf7 |
| institution | Kabale University |
| issn | 2755-9734 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Mental Health |
| spelling | doaj-art-d81d1426eb40481eaa90bb477dd7bdf72025-01-21T06:10:14ZengBMJ Publishing GroupBMJ Mental Health2755-97342025-01-0128110.1136/bmjment-2024-301270Cost-utility of behavioural activation for mitigating psychological impacts of COVID-19 on socially isolated older adults with depression and multiple long-term conditions compared with usual care: results from a pragmatic randomised controlled trialSimon Gilbody0Caroline Fairhurst1Catherine Hewitt2Dean McMillan3Carolyn Chew-Graham4Della Bailey5David Ekers6Steve Parrott7Elizabeth Littlewood8Peter Coventry9Han-I Wang10Kalpita Baird11Health Sciences, University of York, York, UKHealth Sciences, University of York, York, UKHealth Sciences, University of York, York, UKHealth Sciences, University of York, York, UKSchool of Medicine, Keele University, Keele, UKHealth Sciences, University of York, York, UKHealth Sciences, University of York, York, UKHealth Sciences, University of York, York, UKHealth Sciences, University of York, York, UKHealth Sciences, University of York, York, UKHealth Sciences, University of York, York, UKHealth Sciences, University of York, York, UKBackground Depression alongside multiple long-term conditions (MLTCs) in older adults poses a critical public health challenge, worsening physical and mental health and increasing healthcare costs. COVID-19 restrictions further exacerbated these impacts. Behavioural activation (BA) shows promise as a remote intervention for depression during isolation, but its cost-effectiveness for depressed, socially isolated older adults remains uncertain.Objective This study aimed to assess the cost-utility of BA versus usual care for older adults with depression and MLTCs during COVID-19 restrictions.Methods A randomised controlled trial recruited and randomised individuals aged 65 and over with depressive symptoms and MLTC (n=435) to either the BA intervention or usual care. Costs were measured from the perspective of the National Health Service and personal social services. Quality-adjusted life years (QALYs) were measured using the EQ-5D-3L at baseline, and 1, 3 and 12 months postrandomisation. Incremental cost-effectiveness ratios were calculated, with uncertainty addressed through non-parametric bootstrapping. Sensitivity analyses were conducted to assess the robustness of the primary analysis.Findings Primary analysis indicated that BA generated a small cost-saving (£62.34 per older adult; 95% CI: −£120.44 to £239.70) while QALY improvements remained unchanged (0.007; 95% CI −0.036 to 0.022) compared with usual care. The probability of BA being the preferred option is 0.71. Sensitivity analyses supported the primary analysis findings, confirming their robustness.Conclusions and clinical implications Compared with usual care, BA demonstrated a slight cost reduction while maintaining QALY improvement. The findings provide promise for BA interventions for older people with depression and MLTCs facing isolation.https://mentalhealth.bmj.com/content/28/1/e301270.full |
| spellingShingle | Simon Gilbody Caroline Fairhurst Catherine Hewitt Dean McMillan Carolyn Chew-Graham Della Bailey David Ekers Steve Parrott Elizabeth Littlewood Peter Coventry Han-I Wang Kalpita Baird Cost-utility of behavioural activation for mitigating psychological impacts of COVID-19 on socially isolated older adults with depression and multiple long-term conditions compared with usual care: results from a pragmatic randomised controlled trial BMJ Mental Health |
| title | Cost-utility of behavioural activation for mitigating psychological impacts of COVID-19 on socially isolated older adults with depression and multiple long-term conditions compared with usual care: results from a pragmatic randomised controlled trial |
| title_full | Cost-utility of behavioural activation for mitigating psychological impacts of COVID-19 on socially isolated older adults with depression and multiple long-term conditions compared with usual care: results from a pragmatic randomised controlled trial |
| title_fullStr | Cost-utility of behavioural activation for mitigating psychological impacts of COVID-19 on socially isolated older adults with depression and multiple long-term conditions compared with usual care: results from a pragmatic randomised controlled trial |
| title_full_unstemmed | Cost-utility of behavioural activation for mitigating psychological impacts of COVID-19 on socially isolated older adults with depression and multiple long-term conditions compared with usual care: results from a pragmatic randomised controlled trial |
| title_short | Cost-utility of behavioural activation for mitigating psychological impacts of COVID-19 on socially isolated older adults with depression and multiple long-term conditions compared with usual care: results from a pragmatic randomised controlled trial |
| title_sort | cost utility of behavioural activation for mitigating psychological impacts of covid 19 on socially isolated older adults with depression and multiple long term conditions compared with usual care results from a pragmatic randomised controlled trial |
| url | https://mentalhealth.bmj.com/content/28/1/e301270.full |
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