Cost effectiveness of an intervention focused on reducing bathing disability

Abstract

The onset of bathing disability among older people is critical for a decline in functioning and has implications for both the individuals' quality of life and societal costs. The aim of this study was to evaluate long-term cost effectiveness of an intervention targeting bathing disability among older people. For hypothetical cohorts of community-dwelling older people with bathing disability, transitions between states of dependency and death were modelled over 8 years including societal costs. A five-state Markov model based on states of dependency was used to evaluate Quality-adjusted life years (QALYs) and costs from a societal perspective. An intervention group was compared with a no intervention control group. The intervention focused on promoting safe and independent performance of bathing-related tasks. The intervention effect, based on previously published trials, was applied in the model as a 1.4 increased probability of recovery during the first year. Over the full follow-up period, the intervention resulted in QALY gains and reduced societal cost. After 8 years, the intervention resulted in 0.052 QALYs gained and reduced societal costs by €2410 per person. In comparison to the intervention cost, the intervention effect was a more important factor for the magnitude of QALY gains and long-term societal costs. The intervention cost had only minor impact on societal costs. The conclusion was that an intervention targeting bathing disability among older people presents a cost-effective use of resources and leads to both QALY gains and reduced societal costs over 8 years.

Keywords: Cost effectiveness; Occupational therapy intervention; QALY; Reablement.

Fig. 1

Markov model of transitions between states of dependency and death. Each arrow represents a possible transition (i.e. recovery, stability or decline) between two states over a 1-year cycle. Mild dependency refers to a state in which a person is independent in personal activities of daily living (PADL), is dependent in a single instrumental activity of daily living (IADL) and needs help no more than one time per week. Moderate dependency refers to a state in which a person is independent in PADL, is regularly dependent in more than one IADL and needs help more than one time per week. Severe dependency refers to a state in which a person is dependent in one PADL and more than one IADL and needs help one or several times per day. Total dependency refers to a state in which a person is dependent in at least one PADL and IADLs and needs help one or several times per day and lives at a special housing