Cost-utility of a visiting service for older widowed individuals: randomised trial.
BACKGROUND
Despite a growing understanding of the effectiveness of bereavement interventions and the groups that benefit most from them, we know little about the cost-effectiveness of bereavement interventions.


METHODS
We conducted a cost-utility analysis alongside a randomized clinical trial on a visiting service for older widowed individuals (n=110) versus care as usual (CAU; n=106). The visiting service is a selective bereavement intervention that offers social support to lonely widows and widowers by a trained volunteer. Participants were contacted 6-9 months post-loss. Eleven percent of all contacted persons responded and eight percent participated in the trial. The primary outcome measure was quality adjusted life years (QALYs) gained (assessed with the EQ-5D), which is a generic measure of health status. Costs were calculated from a societal perspective excluding costs arising from productivity losses. Using the bootstrap method, we obtained the incremental cost utility ratio (ICUR), projected these on a cost-utility plane and presented as an acceptability curve.


RESULTS
Overall, the experimental group demonstrated slightly better results against slightly higher costs. Whether the visiting service is acceptable depends on the willingness to pay: at a willingness to pay equal to zero per QALY gained, the visiting service has a probability of 31% of being acceptable; beyond euro20,000, the visiting service has a probability of 70% of being more acceptable than CAU.


CONCLUSIONS
Selective bereavement interventions like the visiting service will not produce large benefits from the health economic point of view, when targeted towards the entire population of all widowed individuals. We recommend that in depth analyses are conducted to identify who benefits most from this kind of interventions, and in what subgroups the incremental cost-utility is best. In the future bereavement interventions are then best directed to these groups.


BACKGROUND
Controlled trials ISRCTN17508307.
Onrust
Simone
S
Netherlands Institute of Mental Health and Addiction (Trimbos-instituut), P,O, Box 725, 3500 AS, Utrecht, The Netherlands. sonrust@trimbos.nl
Smit
Filip
F
Willemse
Godelief
G
van den Bout
Jan
J
Cuijpers
Pim
P
D000368:Aged; D000369:Aged, 80 and over; D001601:Bereavement; D003152:Community Health Nursing / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006126:Group Processes; D006304:Health Status; D006801:Humans; D008132:Loneliness / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011314:Preventive Health Services / Q000191:economics; D011594:Psychometrics; D019057:Quality-Adjusted Life Years; D017805:Widowhood / Q000523:psychology* / Q000706:statistics & numerical data