A cost-effectiveness study of ICT training among the visually impaired in the Netherlands

Abstract

BackgroundDue to the ageing population, the number of visually impaired people in the Netherlands will increase. To ensure the future availability of services in rehabilitative eye care, we aim to assess the cost-effectiveness of information and communication technology (ICT) training among visually impaired adults from a societal perspective, using primary data from two large rehabilitative eye care providers in the Netherlands.MethodsParticipants were asked to fill in a questionnaire, which used six different instruments at three different time points: pre training, post training and three months post training. We investigated whether the participants’ quality of life and well-being improved after the training and whether this improvement persisted three months post training. Economic evaluation was conducted by comparing costs and outcomes before and after training. Quality of life and well-being were derived from the EQ-5D and ICECAP-O, respectively. Costs for productivity losses and medical consumption were obtained from the questionnaires. Information regarding the costs of training sessions was provided by the providers.ResultsThirty-eight participants filled in all three questionnaires. The mean age at baseline was 63 years (SD = 16). The effect of ICT training on ICT skills and participants’ well-being was positive and persisted three months after the last training session. Assuming these effects remain constant for 10 years, this would result in an incremental cost-effectiveness ratio (ICER) of € 11,000 per quality-adjusted life-year (QALY) and € 8000 per year of well-being gained, when only the costs of ICT training are considered. When the total costs of medical consumption are included, the ICER increases to € 17,000 per QALY gained and € 12,000 per year of well-being gained. Furthermore, when the willingness-to-pay threshold is € 20,000 per year of well-being, the probability that ICT training will be cost-effective is 75% (91% when including only the costs of ICT training).ConclusionOur study suggests that ICT training among the visually impaired is cost-effective when the effects of ICT training on well-being persist for several years. However, further research involving a larger sample and incorporating long-term effects should be conducted.

ICECAP-O, the current state of play: a systematic review of studies reporting the psychometric properties and use of the instrument over the decade since its publication

“…Nine of the 22 studies reported results from full economic evaluations (assessing both costs and outcomes): six cost-effectiveness analyses [ 49 , 50 , 57 – 62 ] (two of these were feasibility studies), and three cost-consequence analyses [ 15 , 63 – 65 ]. Thirteen studies reported partial economic evaluations, of which five were pilot or feasibility studies.…”

“…Some of the 22 studies evaluated interventions falling clearly within the health domain (such as telehealth [57, 58]; techniques/hardware used in hip fracture surgery [66, 67]; screening for those at risk of lung cancer [68]; comprehensive assessment and personalised clinical management strategies to reduce incontinence and nocturia for older adults following hip fracture [53]; comprehensive assessment for frail older people receiving acute hospital care [56]; and a pharmaceutical product [55]. However, most of the studies that were identified evaluated interventions relating to care in a community setting/self-care and/or integrated services for those with chronic and long-term conditions, where broader elements of quality of life (such as maintaining independence) would be more obviously and/or directly affected; the interventions here included: integrated health and social care [49, 52]; control over budgets for older people receiving community care in Australia [48]; a dementia self-management group [63]; a goal setting programme to promote healthy ageing and prevent dementia for those with low (or zero) needs [60]; information and communication technologies (ICT) training for those with a visual impairment [50]; interventions targeting post-acute needs [46, 54, 64, 65, 69]; and a programme of community activities aimed to help those with low (or zero) level needs to improve and maintain well-being [70]. Milne et al studied the impact of GPS devices for those with a cognitive impairment [15] and Boots et al assessed the impact of a blended care self-management program for family caregivers of people with early cognitive impairment [51].…”

“…Five of the 22 full and partial economic evaluation studies combine the change in ICECAP-O score with time [46, 49, 50, 52, 57, 58, 62]. Each study defines the results using different terminology: ‘An improvement from no capability to full capability on the ICECAP-O scale’ [57, 58]; ‘Capability QALY’ [49, 52]; ‘Years of well-being’ [50]; ‘QALY’ [46]; and ‘Capability Adjusted Life Years (CALYs)’ [62].…”

“…Three of the full economic evaluation studies undertook a net benefit analysis using the ICECAP-O and plotted a cost-effectiveness acceptability curve [49, 50, 52, 57, 58]. Two of the three studies also produced an ICER from the ICECAP-O results [50, 57, 58].…”

Capability instruments in economic evaluations of health-related interventions: a comparative review of the literature

“…The presentation of results in the included economic evaluations demonstrate that there is a lack of consensus regarding the most appropriate way to use capability instruments in economic evaluations. Some authors present cost and outcome data separately and conduct a cost-consequence analysis [42][43][44][45], whilst others reported the results following the idea behind the incremental cost-effectiveness ratio (ICER) [31,46]. This lack of consensus about the use of capability instruments in decision making relates to the different approaches taken by different research groups to valuation, which means that in practice these measures are not comparable along the lines of a QALY.…”