Wang Han-I, Gilbody Simon, Littlewood Elizabeth, Baird Kalpita, Ekers David, McMillan Dean, Bailey Della, Chew-Graham Carolyn, Coventry Peter, Fairhurst Caroline, Hewitt Catherine, Parrott Steve
Health Sciences, University of York, York, UK
Health Sciences, University of York, York, UK.
BMJ Ment Health. 2025 Jan 19;28(1):e301270. doi: 10.1136/bmjment-2024-301270.
Depression alongside multiple long-term conditions (MLTCs) in older adults poses a critical public health challenge, worsening physical and mental health and increasing healthcare costs. COVID-19 restrictions further exacerbated these impacts. Behavioural activation (BA) shows promise as a remote intervention for depression during isolation, but its cost-effectiveness for depressed, socially isolated older adults remains uncertain.
This study aimed to assess the cost-utility of BA versus usual care for older adults with depression and MLTCs during COVID-19 restrictions.
A randomised controlled trial recruited and randomised individuals aged 65 and over with depressive symptoms and MLTC (n=435) to either the BA intervention or usual care. Costs were measured from the perspective of the National Health Service and personal social services. Quality-adjusted life years (QALYs) were measured using the EQ-5D-3L at baseline, and 1, 3 and 12 months postrandomisation. Incremental cost-effectiveness ratios were calculated, with uncertainty addressed through non-parametric bootstrapping. Sensitivity analyses were conducted to assess the robustness of the primary analysis.
Primary analysis indicated that BA generated a small cost-saving (£62.34 per older adult; 95% CI: -£120.44 to £239.70) while QALY improvements remained unchanged (0.007; 95% CI -0.036 to 0.022) compared with usual care. The probability of BA being the preferred option is 0.71. Sensitivity analyses supported the primary analysis findings, confirming their robustness.
Compared with usual care, BA demonstrated a slight cost reduction while maintaining QALY improvement. The findings provide promise for BA interventions for older people with depression and MLTCs facing isolation.
老年人的抑郁症与多种长期疾病（MLTCs）并存构成了一项严峻的公共卫生挑战，会使身心健康恶化并增加医疗成本。新冠疫情限制措施进一步加剧了这些影响。行为激活（BA）作为隔离期间抑郁症的远程干预手段显示出前景，但对于抑郁且社会孤立的老年人而言，其成本效益仍不确定。
本研究旨在评估在新冠疫情限制期间，行为激活与常规护理相比，对患有抑郁症和多种长期疾病的老年人的成本效用。
一项随机对照试验招募了年龄在65岁及以上、有抑郁症状且患有多种长期疾病的个体（n = 435），将其随机分为行为激活干预组或常规护理组。成本从英国国家医疗服务体系和个人社会服务的角度进行衡量。使用EQ - 5D - 3L在基线、随机分组后1个月、3个月和12个月测量质量调整生命年（QALYs）。计算增量成本效益比，并通过非参数自举法处理不确定性。进行敏感性分析以评估主要分析的稳健性。
主要分析表明，与常规护理相比，行为激活产生了少量成本节省（每位老年人节省62.34英镑；95%CI：-120.44英镑至239.70英镑），而质量调整生命年的改善保持不变（0.007；95%CI -0.036至0.022）。行为激活成为首选方案的概率为0.71。敏感性分析支持主要分析结果，证实了其稳健性。
与常规护理相比，行为激活在维持质量调整生命年改善的同时，成本略有降低。这些发现为面临隔离的患有抑郁症和多种长期疾病的老年人的行为激活干预提供了前景。
