IMPACT OF BEHAVIORAL INTERVENTIONS FOR CHRONIC DISEASES ON HEALTH UTILITY- ASSESSMENT OF THREE TRIALS OF OLDER ADULTS

OBJECTIVES: To describe our experience using utility measures in three behavioral intervention (BI) trials in older adults; the three diseases were depression, diabetes, and dementia. METHODS: Goal of the diabetes trial was to test efficacy of behavioral activation (BA), which incorporated active participation and goal-setting over 6 months to improve eye exam adherence among older diabetic African Americans, or supportive therapy (ST) attention-control. In the depression trial, patients were randomized to Beat the Blues (BTB), which incorporated 10 social worker sessions over 4 months for depression education and stress management, or usual care control. In the dementia trial, patients were randomized to the Tailored Activity Program (TAP), which included up to 8 occupational therapy sessions over 6 months to improve caregivers’ management of dementia behaviors, or health education control. Utility was measured in the studies as follows: diabetes study – Visual Function Questionnaire (VFQ); depression study – EuroQoL 5-Dimension, 3-Level (EQ-5D-3L) and Health Utilities Instrument Mark 3 (HUI-3); dementia study – EuroQoL 5-Dimension, 5-Level (EQ-5D-5L) and Health Utilities Instrument Mark 2 (HUI-2). Change in utility was calculated for each study. RESULTS: In the diabetes study, VFQ utility increased 0.002 (0.669-0.671) in BA and decreased 0.002 (0.658-0.656) in ST. In the depression study, EQ-5D-3L utility increased by 0.099 (0.566-0.665) for BTB and by 0.053 (0.582-0.635) for control; HUI-3 increased 0.144 (0.335-0.479) for BTB and 0.74 (0.432-0.496) for control. In the dementia study, TAP decreased in EQ-5D-5L utility by 0.0206 (0.7719-0.7513), while control decreased by 0.0212 (0.7821-0.7619); HUI-2 decreased by 0.0294 (0.4606-0.4317) for TAP and by 0.01925 (0.4655-0.4462) for control. CONCLUSIONS: Utility measures were modestly impacted in these trials. BI researchers of chronic diseases in older adults should carefully weigh the benefits of including utility instruments versus other factors such as the potential for limited impact and time and cost burdens of the utility measures.