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Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial

Author

Listed:
  • Henderson, Catherine
  • Knapp, Martin
  • Fernández, José-Luis
  • Beecham, Jennifer
  • Hirani, Shashivadan P.
  • Beynon, Michelle
  • Cartwright, Martin
  • Rixon, Lorna
  • Doll, Helen
  • Bower, Peter
  • Steventon, Adam
  • Rogers, Anne
  • Fitzpatrick, Ray
  • Barlow, James
  • Bardsley, Martin
  • Newman, Stanton P.

Abstract

Purpose of the study: to examine the costs and cost-effectiveness of ‘second-generation’ telecare, in addition to standard support and care that could include ‘first-generation’ forms of telecare, compared with standard support and care that could include ‘first-generation’ forms of telecare. Design and methods: a pragmatic cluster-randomised controlled trial with nested economic evaluation. A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas. In the Whole Systems Demonstrator Telecare Questionnaire Study, 550 participants were randomised to intervention and 639 to control. Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months, additional to their standard health and social care services. The control group received usual health and social care. Primary outcome measure: incremental cost per quality-adjusted life year (QALY) gained. The analyses took a health and social care perspective. Results: cost per additional QALY was £297,000. Cost-effectiveness acceptability curves indicated that the probability of cost-effectiveness at a willingness-to-pay of £30,000 per QALY gained was only 16%. Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £161,000 per QALY. Implications: while QALY gain in the intervention group was similar to that for controls, social and health services costs were higher. Second-generation telecare did not appear to be a cost-effective addition to usual care, assuming a commonly accepted willingness to pay for QALYs. Trial registration number: ISRCTN 43002091.

Suggested Citation

  • Henderson, Catherine & Knapp, Martin & Fernández, José-Luis & Beecham, Jennifer & Hirani, Shashivadan P. & Beynon, Michelle & Cartwright, Martin & Rixon, Lorna & Doll, Helen & Bower, Peter & Steventon, 2014. "Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial," LSE Research Online Documents on Economics 57270, London School of Economics and Political Science, LSE Library.
    • Handle: RePEc:ehl:lserod:57270
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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
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    4. Andrea Manca & Neil Hawkins & Mark J. Sculpher, 2005. "Estimating mean QALYs in trial‐based cost‐effectiveness analysis: the importance of controlling for baseline utility," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 487-496, May.
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    Cited by:

    1. Helen Weatherly & Rita Faria & Bernard Van den Berg & Mark Sculpher & Peter O’Neill & Kay Nolan & Julie Glanville & Jaana Isojarvi & Erin Baragula & Mary Edwards, 2017. "Scoping review on social care economic evaluation methods," Working Papers 150cherp, Centre for Health Economics, University of York.
    2. Chiranjeev Sanyal & Paul Stolee & Don Juzwishin & Don Husereau, 2018. "Economic evaluations of eHealth technologies: A systematic review," PLOS ONE, Public Library of Science, vol. 13(6), pages 1-11, June.
    3. Kate Hamblin, 2022. "Sustainable Social Care: The Potential of Mainstream “Smart” Technologies," Sustainability, MDPI, vol. 14(5), pages 1-21, February.
    4. Kevin Momanyi, 2018. "A Structural Model of The Demand For Telecare," 2018 Papers pmo1170, Job Market Papers.
    5. Barlow, J & Knapp, M & Comas-Herrera, A & Damant, J & Freddolino, P & Hamblin, K & Hu, B & Lorenz, K & Perkins, M & Rehill, A & Wittenberg, R & Woolham, J, 2015. "The case for investment in technology to manage the global costs of dementia," Working Papers 72399, Imperial College, London, Imperial College Business School.
    6. Toms, G. & Verity, F. & Orrell, A., 2019. "Social care technologies for older people: Evidence for instigating a broader and more inclusive dialogue," Technology in Society, Elsevier, vol. 58(C).
    7. Andrea Gabrio & Alexina J. Mason & Gianluca Baio, 2017. "Handling Missing Data in Within-Trial Cost-Effectiveness Analysis: A Review with Future Recommendations," PharmacoEconomics - Open, Springer, vol. 1(2), pages 79-97, June.

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    More about this item

    Keywords

    telecare; economic evaluation; social care; older people;
    All these keywords.

    JEL classification:

    • I31 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - General Welfare, Well-Being

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