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

Abstract

Purpose 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.

Exploring a career pathway for home support workers in Ireland: a systematic scoping review of the international evidence

“…Sector economic perspectives: Research internationally highlights sector challenges of financial sustainability, pay equity, market challenges, and the cost-effectiveness of training programmes ( 111 – 113 ). Economic perspectives include de-investment decisions ( 114 ) and the economic benefits of health promoting interventions for prevention of functional loss and promoting quality of life ( 115 ).…”