Occupation-focused health promotion for well older people — A cost-effectiveness analysis

Abstract

Introduction: The aim of this study was to evaluate three occupational therapy interventions, focused on supporting continued engagement in occupation among older people, to determine which intervention was most cost effective, evaluated as the incremental cost/quality adjusted life year gained. Method: The study was based on an exploratory randomized controlled trial. Participants were 77-82 years, single living and without home help. One hundred and seventy seven persons were randomized to an individual intervention, an activity group, a discussion group or a no intervention control group. All interventions focused on supporting the participants to maintain or improve occupational engagement. Outcomes were evaluated at baseline, three and 12 months and included general health and costs (intervention, municipality and health care). Based on linear regression models, we evaluated how outcomes had changed at each follow-up for each intervention group in relation to the control group. Results: Both group interventions resulted in quality adjusted life years gained at three months. A sustained effect on quality adjusted life years gained and lower total costs indicated that the discussion group was the most cost-effective intervention. Conclusion: Short-term, occupation-focused occupational therapy intervention delivered in group formats for well older people resulted in quality-adjusted life years gained. A one-session discussion group was most cost effective.

Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019: a scoping review to guide decision making in a Swedish municipality context

“…Four studies presented a health-economic evaluation. Three studies adopted a cost-effectiveness analysis method [13,72,102] and one a cost-utility analysis method [90]. Two studies provided an economic evaluation of single interventions; a case-management intervention [90] and an education programme for home visitors [102].…”

“…Two studies provided an economic evaluation of single interventions; a case-management intervention [90] and an education programme for home visitors [102]. The other two studies compared different interventions focused on health promotion [13], and falls prevention [72]. In these four studies, a societal perspective was chosen including cost from different sectors e.g., health care and social care.…”

“…Several studies show that health promotion and prevention in different forms have resulted in a range of positive effects such as maintenance of ability to perform ADLs [7], enhanced quality of life [8,9], prevention of functional decline [10,11], and reduced falls [12]. In addition, some interventions have shown to be cost-effective [13,14]. In all, examples in the previous literature indicates that positive effects can be achieved from both multi-professional and single-professional interventions [10,15], from both short and long-term interventions [16,17] and both group-based and individual interventions [10,18].…”

Exploring reach and experiences of participation in health-promoting senior meetings in a municipality context

“…A range of health-promoting and preventive interventions have been shown to result in positive effects for older people (Vass et al 2005;Gustafsson et al 2013;Rasinaho et al 2012;Zingmark et al 2014). If implemented, such interventions can promote health and well-being and thereby affect the expected increase in costs for health and social care (Ministry of Health and Social Affairs 2010; Zingmark et al 2016). Therefore, municipalities should consider implementing health promotion for community-dwelling older people.…”

“…Recent trials have shown that health-promoting senior meetings result in better outcomes on activities of daily living (ADL) (Gustafsson et al 2013;Zingmark et al 2014), leisure engagement (Zingmark et al 2014), self-rated health (Zingmark et al 2014), and physical function (Zidén et al 2014), compared to no intervention. In addition, groupbased interventions seem to be more effective than individual approaches (Gustafsson et al 2012;Zingmark et al 2016). These trials have adopted a single-professional (Zingmark et al 2014) or a multi-professional (Gustafsson et al 2012) design, including one (Zingmark et al 2014), four (Gustafsson et al 2013) or eight (Zingmark et al 2014) sessions, all leading to positive effects.…”