Clinical Interventions in Aging (Dec 2021)

Economic Evaluation of a Reablement Training Program for Homecare Staff Targeting Sedentary Behavior in Community-Dwelling Older Adults Compared to Usual Care: A Cluster Randomized Controlled Trial

  • Rooijackers TH,
  • Metzelthin SF,
  • van Rossum E,
  • Kempen GIJM,
  • Evers SMAA,
  • Gabrio A,
  • Zijlstra GAR

Journal volume & issue
Vol. Volume 16
pp. 2095 – 2109

Abstract

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Teuni H Rooijackers,1,2 Silke F Metzelthin,1,2 Erik van Rossum,1– 3 Gertrudis IJM Kempen,1,2 Silvia MAA Evers,1 Andrea Gabrio,4 GA Rixt Zijlstra1 1Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; 2Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands; 3Research Center for Community Care, Academy of Nursing, Zuyd University of Applied Sciences, Heerlen, the Netherlands; 4Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, the NetherlandsCorrespondence: Teuni H RooijackersDepartment of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the NetherlandsTel +31 43-388-1711Email [email protected]: Training and supporting homecare staff in reablement aims to change staff behavior from “doing for” to “doing with” older adults and is assumed to benefit the health and quality of life of older adults and reduce healthcare utilization and costs. This study evaluated the cost-effectiveness and cost-utility of the staff reablement training program “Stay Active at Home” (SAaH) from a societal perspective.Participants and Methods: An economic evaluation was embedded in a 12-month cluster randomized controlled trial. Ten Dutch homecare nursing teams participated (n = 313 staff members), of which five teams were trained in reablement and the other five provided usual care. Cost and effect data were collected from 264 older adults at baseline, 6 and 12 months. Costs included “intervention,” “healthcare,” and “patient and family” costs (collectively, societal costs) and were assessed using questionnaires and client records or estimated by bottom-up micro-costing. Effects included sedentary behavior and quality-adjusted life years (QALYs). Multiple imputed bootstrapped data were used to generate cost-effectiveness planes and acceptability curves.Results: No statistically significant differences were observed between the intervention and control group in terms of sedentary time (adjusted mean difference: 4.8 minutes [95% CI – 26.4, 36.0]), QALYs ( 0.01 [95% CI – 0.03, 0.04]), and societal costs ( € 2216 [95% CI – 459, 4895]), except lower costs for domestic help in the intervention group ( €– 173 [95% CI – 299, – 50]). The probability that SAaH was cost-effective compared to usual care ranged from 7.1% to 19.9%, depending on the willingness-to-pay (WTP) (€ 0‒€ 50,000)/minute of sedentary time averted and was 5.9% at a WTP of € 20,000/QALY gained.Conclusion: SAaH did not improve outcomes or reduce costs and was not cost-effective from a societal perspective compared to usual care in Dutch older adults receiving homecare. Consequently, there is insufficient evidence to justify widespread implementation of the training program in its current form.Trial Registration: ClinicalTrials.gov: NCT03293303.Keywords: cluster randomized controlled trial, cost-effectiveness, cost-utility, home and community-based care services, independence, aged

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