Age and Ageing Advance Access originally published online on November 10, 2004
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Age and Ageing Vol. 34 No. 1 © British Geriatrics Society 2004; all rights reserved
Research Paper |
Occupational therapy compared with social work assessment for older people. An economic evaluation alongside the CAMELOT randomised controlled trial
1 St Bartholomew School of Nursing and Midwifery, City University, Philpot Street, London E1 2EA, UK
2 School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK
3 School of Allied Health Professions, University of East Anglia, Norwich NR4 7TJ, UK
4 Gt Yarmouth Primary Care Trust, Ferryside, High Rd, Great Yarmouth NR31 0PH, UK
Address correspondence to: M. Mugford. Fax: (+44) 1603 593752. Email: m.mugford{at}uea.ac.uk
Abstract
Objectives: to compare costs and outcome of occupational therapy-led assessment with social worker-led assessment of older people, in terms of their independence and quality of life.
Design: cost-effectiveness analysis alongside a randomised controlled trial. The analysis took viewpoints of health services and patients. The primary outcome measure for cost-effectiveness was dependency using the Community Dependency Index (CDI). Secondary outcomes included utility scores based on the EuroQoL (EQ-5D). Resource use was measured for each patient, from clinical records and from patient carer interviews at 8 months. Unit costs of health and social care resources were derived from local sources and national datasets. Cost-effectiveness was analysed using cost-effectiveness acceptability curves.
Results: there were no differences between the two arms of the trial in terms of cost-effectiveness. There is an apparent increase in mean cost per case for the occupational therapy arm but this is not statistically significant (mean difference in cost per case £542, 95% CI £434–1,519). Mean total costs of care per participant were £4,379 and £3,837 for the occupational therapy and social work arms, respectively. At best the intervention would improve outcomes at a cost of £14,000 per quality-adjusted life year (QALY). The probability of such an outcome was <50%.
Conclusions: from a policy perspective, the lack of difference in clinical and cost-effectiveness means that either a social work or an occupational therapy service is successful in making care assessments that enable an older person to remain in their own home.
Keywords: community, economic evaluation, older people, occupational therapy, randomised controlled trial, elderly
Received October 21, 2004; accepted in revised form August 6, 2004.