Cost-utility of behavioural activation for mitigating psychological impacts of COVID-19 on socially isolated older adults with depression and multiple long-term conditions compared with usual care: results from a pragmatic randomised controlled trial

Cost-Utility of Behavioral Activation for Older Adults during COVID-19

Background

Depression in older adults, especially those with multiple long-term conditions, is a major public health issue. It affects both mental and physical health and raises healthcare costs. The COVID-19 pandemic has made these challenges worse. Behavioral Activation (BA) is a potential solution for helping older adults cope with depression during isolation, but its cost-effectiveness compared to usual care is unclear.

Objective

This study evaluated the cost-utility of BA versus usual care for older adults with depression and multiple long-term conditions during COVID-19 restrictions.

Methods

We conducted a randomized controlled trial involving 435 individuals aged 65 and older with depressive symptoms and multiple long-term conditions. Participants were assigned to receive either BA or usual care. We measured costs from the perspective of the National Health Service and personal social services. Quality-adjusted life years (QALYs) were assessed at different time points: baseline, and 1, 3, and 12 months after randomization. We calculated incremental cost-effectiveness ratios and performed sensitivity analyses to ensure our findings were reliable.

Findings

The primary analysis showed that BA resulted in a small cost-saving of £62.34 per older adult, while quality of life improvements (QALYs) were similar between both groups. There is a 71% chance that BA is the preferred treatment option. Sensitivity analyses confirmed these results.

Conclusions and Clinical Implications

BA is slightly more cost-effective than usual care while providing similar improvements in quality of life. This suggests that BA could be a valuable intervention for older adults with depression and multiple long-term conditions who are experiencing isolation.

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