Work-Package 4: Valuation

To effectively improve the mental well-being of older Europeans with co-morbid mental health, cognitive and sensory impairments requires, an understanding of the health economic aspects of these combined problems is essential. In this Work Package (WP), we are studying the health economic resource use and associated cost of the interaction among mental and cognitive health aspect(s) and sensory impairment in the existing EU population databases. This involves estimating the cost of health care resource utilisation of mental health and sensory impairment (visits to the doctor, visits to the GP and hospitalisations) for the older population based on the pan-European SHARE (Survey of Health Ageing and Retirement in Europe) meta-dataset, which includes data from the older population in Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain, and Switzerland.
Another task in this WP is has been the preparatory work for ascertaining the cost-effectiveness of the sensory support intervention developed in WP3, which is to be trialled in the next phase of work in WP3. To do this, we first had to determine the best tools to measure resource use and quality of life in dementia-related interventions. This involved a detailed systematic review of the literature, as well as a focus group with dementia experts, which included nurses, clinical researchers in dementia and other health economists. These studies revealed that the Client Services Receipt Inventory (CSRI) is the most suitable choice to ascertain resource use and EuroQol 5-dimension (EQ-5D), Short Form-12 (SF-12) and disease-specific DEMQOL are best-suited to measure quality of life. This enabled us to develop our health economics’ data collection tools for the SENSE-Cog RCT, together with the Trial Development Team from WP3, and test out their utility and acceptability in WP3’s SENSE-Cog Field Trial of the draft intervention.

Results and potential impact

Our econometric analyses from the SHARE meta-dataset have already contributed important new findings by revealing that, in some cases, cognitive and sensory impairments are significantly associated with higher utilisation of health care services (more hospitalisations and more GP visits), even after controlling for other major health conditions. This has important implications and strengthens the case for improved recognition and support of these frequently co-occurring conditions in older people in Europe.  Furthermore, this work has resulted in an important technical paper in which methods of analysis have been outlined.

The preparatory work for the SENSE-Cog RCT, including the critical review of tools for dementia-related cost effectiveness evaluations, is also a significant contribution to the field of dementia studies. The findings now enable us to determine the best available resource use and quality of life scales for dementia-related trial health economic analyses. The tools chosen for the RCT entailed translation into Greek and French, which we have done, thereby contributing to greater accessibility to these important instruments and fostering standardisation of cost effectiveness assessment across centres.  Determining the cost effectiveness of a new intervention such as SENSE-Cog’s ‘sensory support intervention’ is a crucial aspect of ensuring that the intervention, if efficacious, is eventually implemented in clinical services across the EU.