Cost-effectiveness of life-review for older adults with moderate depressive symptomatology: A pragmatic randomized controlled trial

• Study on the cost-effectiveness of life-review compared to care-as-usual
• Sample of 202 Dutch older adults with depressive symptoms, collected in 2009
• Against higher costs life-review is more effective in reducing depressive symptoms.
• Whether life-review offers good value for money depends on the willingness to pay for a favorable outcome.
• Life-review by a single therapist and in larger groups improves the cost-effectiveness.

PurposeLife-review has been established as an evidence-based treatment of depression in later life. This study investigates the cost-effectiveness of life-review compared to care-as-usual.MethodsAn economic evaluation alongside a randomized controlled trial was carried out, comparing life-review (n = 100) to care-as-usual (n = 102). Individuals of 55 years and over, with moderate depressive symptomatology, were included. Treatment response was defined as a statistically reliable reduction of depressive symptoms on the Center for Epidemiologic Studies Depression scale. Total per-participant costs encompassed intervention costs, costs of receiving other treatments, participants' out-of-pocket expenses, and costs stemming from production losses, and were expressed in (2009) euros (€).ResultsAt 6-month follow-up, treatment response was 54.0% and 27.5% in the life-review and usual-care conditions, respectively. The difference in effectiveness was statistically significant at p = .001 (2-tailed). In the respective conditions the costs were €5550 and €3162, with the higher costs in the intervention arm of the trial. The incremental cost-effectiveness was €8675 (US$10,227) per improved participant.ConclusionThe findings suggest that offering life-review rather than care-as-usual almost doubles the likelihood of a favorable outcome. However, the better clinical outcomes are achieved at greater costs. The conclusion that life-review offers good value for money is sensitive to the willingness to pay for a favorable treatment response. It is recommended that life-review is delivered by a single therapist and in larger groups as this may improve the cost-effectiveness of this intervention.