Social care covers a wide variety of people and support needs, ranging from learning disabilities, safeguarding, mental capacity and autism to physical disabilities, end of life care and dementia. Social care services are vital in offering people who need support the opportunity to live independently at home. Support can include help with everyday tasks such as shopping or cooking (Giebel et al., 2015).
With social care being under budgetary constraints, services are being reshaped (Sutcliffe et al., 2012; Wilberforce et al., 2011) to achieve most cost-effective and high quality options. Telecare may be one such option, as it offers a remote monitoring system that supports people to live independently at home. It allows this through monitoring people’s functioning, home security and home environment.
In this blog I discuss a recently published randomised controlled trial (RCT) on the cost-effectiveness of telecare for people with social care needs by Henderson et al. (2014) published in the peer reviewed journal, Age & Ageing.
The authors selected three local authority areas in England in which 2,600 people with social care needs participated.
Telecare was provided in addition to standard health and social care services, and was therefore coined ‘second-generation telecare’. Participants in the control group only received their standard health and social care services. The intervention lasted a total of 12 months.
In the Whole Systems Demonstrator Telecare Questionnaire Study, 550 participants were randomised to intervention and 639 to control.
Due to missing data and participants dropping out from the study, the analysis of costs and outcomes was based on 375 and 378 participants in the intervention and the control group, respectively, for whom complete data was available.
To measure the cost-effectiveness of this second-generation telecare system, the incremental cost per quality-adjusted life year (QALY) was measured.
Between both groups, there were no significant demographic differences at baseline or at 12-month follow-up, which shows that the groups were randomised effectively.
Interestingly, looking at service usage three months before the intervention shows that the intervention group had the highest usage, including home care and social work.
Data showed that providing second-generation telecare was not statistically significant in changing the QALY. In particular, telecare was 31 percent likely to be cost-effective at a willingness to pay of £30,000 per QALY.
The authors concluded that
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.
Strengths and limitations
This study showed several strengths, such as the relatively large number of participants, which were recruited from three separate local authority regions across England, and the well-applied trial randomisation methodology.
Participants showed no variations in demographic characteristics either at baseline or at the 12-month follow-up, which indicates that demographics did not bias the results.
However, there were some limitations which should be explored in future research. For example, it is possible that the benefits of second-generation telecare varied between subgroups of participants? Perhaps adults with a physical disability benefited differently to people with dementia. It would have therefore been interesting and important to show the range of disability and long term conditions within the sample.
Another possible limitation is that participants may have already received first-generation telecare as part of their standard health and social care package. In this case, second-generation telecare naturally would neither be effective nor cost-effective.
In summary, this large intervention RCT shows the possible benefits of second-generation telecare in people with social care needs on top of their usual health and social care services.
Findings suggest that telecare should rather be integrated in the standard health and social care services, as with first-generation telecare.
Maybe it really is a case of different social care needs benefiting more, or less, from this assistive technology. After all though, it is a non-intrusive technology which can help a larger number of people live at home independently for longer.
Henderson et al. (2014). Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial. Age & Ageing, 43, 794-800. [Abstract]
Giebel, C.M, Sutcliffe, C., & Challis, D. (2015). Activities of daily living and quality of life across different stages of dementia: A UK study. Aging & Mental Health, 19, 63-71. [Abstract]
Sutcliffe, C., et al. (2012). Social Care in Older People’s Services – Facilitating the Flexibe Use of Resources. Care Management Journals, 13(3), 100-107. [PubMed]
Wilberforce, M., et al. (2011). Implementing Consumer Choice in Long-Term Care: The Impact of Individual Budgets on Social Care Providers in England. Social Policy & Administration, 45(5), 593-612. [Abstract]