title: Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial.
abstract: OBJECTIVE
  to examine the costs and cost-effectiveness of 'second-generation' telecare, in addition to standard support and care that could include 'first-generation' forms of telecare, compared with standard support and care that could include 'first-generation' forms of telecare.
  
  
  METHODS
  a pragmatic cluster-randomised controlled trial with nested economic evaluation. A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas. In the Whole Systems Demonstrator Telecare Questionnaire Study, 550 participants were randomised to intervention and 639 to control. Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months, additional to their standard health and social care services. The control group received usual health and social care.
  
  
  METHODS
  incremental cost per quality-adjusted life year (QALY) gained. The analyses took a health and social care perspective.
  
  
  RESULTS
  cost per additional QALY was £297,000. Cost-effectiveness acceptability curves indicated that the probability of cost-effectiveness at a willingness-to-pay of £30,000 per QALY gained was only 16%. Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £161,000 per QALY.
  
  
  CONCLUSIONS
  while QALY gain in the intervention group was similar to that for controls, social and health services costs were higher. Second-generation telecare did not appear to be a cost-effective addition to usual care, assuming a commonly accepted willingness to pay for QALYs.
  
  
  BACKGROUND
  ISRCTN 43002091.
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Henderson
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, UK King's College, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, UK.
authors.forename: José-Luis
authors.initials: JL
authors.lastname: Fernández
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beecham
authors.affiliation: City University, London, UK.
authors.forename: Shashivadan P
authors.initials: SP
authors.lastname: Hirani
authors.affiliation: City University, London, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Beynon
authors.affiliation: City University, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Cartwright
authors.affiliation: City University, London, UK.
authors.forename: Lorna
authors.initials: L
authors.lastname: Rixon
authors.affiliation: University of East Anglia, Norwich, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Doll
authors.affiliation: NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.affiliation: The Nuffield Trust, London, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Steventon
authors.affiliation: University of Southampton, Southampton, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.affiliation: University of Oxford, Oxford, UK.
authors.forename: Ray
authors.initials: R
authors.lastname: Fitzpatrick
authors.affiliation: Imperial College, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Barlow
authors.affiliation: The Nuffield Trust, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Bardsley
authors.affiliation: City University, London, UK.
authors.forename: Stanton P
authors.initials: SP
authors.lastname: Newman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D058998:Remote Sensing Technology / Q000191:economics; D012947:Social Work / Q000191:economics* / Q000379:methods; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics* / Q000379:methods; D013997:Time Factors
keywords: economic evaluation; older people; social care; telecare