Cost-Utility of Behavioral Activation (BA) for Mitigating Psychological Impacts of COVID-19 on Socially Isolated Older Adults With Depression and Multiple Long-Term Conditions Compared With Usual Care

OBJECTIVES: 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

METHODS: 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 and SF-6D at baseline, and one, three and 12 months post randomisation. Incremental cost-effectiveness ratios (ICER) were calculated, with uncertainty addressed through non-parametric bootstrapping. Sensitivity analyses were conducted to assess the robustness of the primary analysis.

RESULTS: Primary analysis indicated that BA generated a small cost-saving (£62.30 per older adult, 95% CI: -£120.40 to £239.70) while maintaining similar QALY improvements compared with usual care. The probability of BA being the preferred option is 71%. Sensitivity analyses supported the primary analysis findings, confirming their robustness.

CONCLUSIONS: Compared to 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.