Certified service dogs - A cost-effectiveness analysis appraisal

Abstract

Introduction: Individuals with functional impairments or chronic diseases are often in need of assistance in their daily lives. For these individuals it is essential to find novel, cost-effective solutions to meet their needs. Service dogs are dogs that are specially trained to assist individuals with functional impairments and may be able to improve these individuals' quality of life at a reasonable cost, i.e. be cost effective. Cost-effectiveness analyses are used to illustrate the cost of an intervention in relation to its effects and provide important input to decision-makers when setting priorities.

Aim: The aim of this study is to assess the cost effectiveness of a certified physical service dog and a diabetes alert dog compared to a regular companion dog.

Method: Costs, life years and quality-adjusted life years were estimated over a 10-year time horizon using a decision-analytic model built upon evidence from the"service and hearing dog project". The primary outcome was the incremental cost-effectiveness ratio expressed as cost per gained quality-adjusted life year. The analysis was conducted from a societal perspective. Costs and effects were discounted with 3% per annum and reported in USD.

Results: Compared to a regular companion dog, a physical service dog is cost saving [-6,000 USD] and gives the dog owner more quality-adjusted life years [0.28]. The diabetes alert dog is also cost effective in comparison with a regular companion dog [-4,500 USD, 0.06 QALYs].

Conclusion: This study indicates that a certified service dog is cost saving in comparison with a regular companion dog for individuals with functional impairments or chronic diseases. The uncertainty of the analysis implies that further studies are needed in order to confirm these results. Nevertheless, physical service dogs and diabetes alert dogs show potential to be a valuable support and decision analytic models are useful tools to provide this information.

Fig 1. Structure of the decision-analytic Markov model.

The decision of training or not training a certified dog is shown in part 1 of the figure. Part 2 describes how owners training a certified dog can experience that the dog is retired or loses its certification and that the human as well as the dog faces an annual risk of dying. Owners not training a dog can move from the ‘Dog not certified’ state to ‘Owner dead’ or ‘Dog dead’ state.

Fig 2. Result of probabilistic analysis for physical service dog owners.

Panel A: Cost-effectiveness plane based on 10,000 iterations illustrating the distribution of the ICERs. Panel B: Cost-effectiveness acceptability curves showing the probability that a certified physical service dog is cost effective at different thresholds for cost effectiveness.

Fig 3. Result of probabilistic analysis for diabetes alert dog owners.

Panel A: Cost-effectiveness plane based on 10,000 iterations illustrating the distribution of the ICERs. Panel B: Cost-effectiveness acceptability curves showing the probability that a certified diabetes alert dog is cost effective at different thresholds for cost effectiveness.