Cost-effectiveness of the FindMyApps eHealth intervention vs. digital care as usual: results from a randomised controlled trial

Figures & data

Table 1. Descriptive statistics of demographic and experimental outcomes of the FindMyApps group and digital care-as-usual group at baseline. Note: N, count; SD, standard deviation.

	FindMyApps	Digital care-as-usual	Difference test	p-value
People with MCI/dementia	N = 76	N = 74
Age (years), mean (SD)	73.2 (9.48)	72.42 (8.77)	t = 0.522	0.602
Gender, N (% female)	34 (44.74%)	29 (39.19%)	Chi2 = 0.273	0.601
Educational level			Chi2 = 3.298	0.192
Low, N (%)	10 (13.16%)	8 (10.81%)
Middle, N (%)	23 (30.26%)	33 (44.59%)
High, N (%)	43 (56.58%)	33 (44.59%)
EQ-5D-5L, mean (SD)	0.91 (0.08)	0.91 (0.08)	t = −0.348	0.728
ASCOT, mean (SD)	0.82 (0.13)	0.82 (0.13)	t = −0.048	0.962
MSPP total diversity score, mean (SD)	12.1 (4.68)	12.34 (4.72)	t = −0.274	0.784
MSPP total frequency score, mean (SD)	2.46 (1.24)	2.35 (1.17)	t = 0.487	0.627
Caregivers	N = 76	N = 74
Age (years), mean (SD)	65.37 (11.45)	62.5 (14.31)	t = 1.354	0.178
Gender (% female)	54 (71.05%)	56 (75.68%)	Chi2 = 0.207	0.649
Educational level			Chi2 = 2.07	0.355
Low, N (%)	7 (9.21%)	3 (4.05%)
Middle, N (%)	31 (40.79%)	36 (48.65%)
High, N (%)	38 (50.99%)	35 (47.30%)
EQ-5D-5L, mean (SD)	0.93 (0.06)	0.92 (0.08)	t = 1.270	0.206
SSCQ, mean (SD)	4.95 (1.92)	5.05 (1.71)	t= −0.291	0.771

Table 2. Multiply imputed effects and costs for the FindMyApps group and digital care-as-usual group after 3 months of follow-up. Note: MSPP-d: MSPP total diversity score; MSPP-f: MSPP total frequency score; SE: standard error; 95% CI: 95% confidence interval. All costs are presented in €.

	FindMyApps		Digital care-as-usual
	Mean (SE)	Range (min; max)	Mean (SE)	Range (min; max)	Mean difference (95% CI)
People with MCI/dementia
EQ-5D-5L	0.91 (0.003)	(0.62; 1.00)	0.91 (0.003)	(0.66; 1.00)	0 (−0.025; 0.023)
ASCOT	0.82 (0.01)	(0.39; 1.00)	0.82 (0.01)	(0.46; 1.00)	−0.003 (−0.051; 0.044)
MSPP-d.	13.52 (0.17)	(4; 25)	12.99 (0.19)	(4; 26)	0.528 (−1.026; 2.058)
MSPP-f.	2.64 (0.04)	(0.55; 5.22)	2.54 (0.05)	(0.6; 6.35)	0.109 (−0.279; 0.488)
Costs
Primary care	276 (14)	(0; 2.623)	280 (16)	(0; 3.024)	−4 (−147; 119)
Secondary care	250 (20)	(0; 3.997)	166 (14)	(0; 2.965)	84 (-46; 262)
Supportive care	2,047 (119)	(0; 17,387)	2.605 (125)	(0; 16,472)	−558 (−1,619; 530)
Informal care	2,166 (111)	(0; 14,942)	2.413 (130)	(0; 16,527)	−247 (−1,328; 787)
Other costs	115 (9)	(0; 1.514)	182 (13)	(0; 2,046)	−68 (−173; 20)
Total health care costs	2592 (126)	(18; 17,405)	3.051 (132)	(0; 16,705)	−459 (−1585; 687)
Total societal costs	4.873 (200)	(18; 22,178)	5.647 (225)	(0; 28,757)	−774 (−2643; 079)
Caregivers
EQ-5D-5L	0.9 (0.001)	(0.8; 0.95)	0.92 (0.002)	(0.63; 0.96)	0.013 (−0.002; 0.032)
SSCQ	5.16 (0.06)	(0; 7)	4.41 (0.08)	(0; 7)	0.754 (0.139; 1.382)
Costs
Primary care	116 (5)	(0; 661)	190 (12)	(0; 1.548)	−74 (−170; −6)
Secondary care	98 (6)	(0; 908)	184 (12)	(0; 2.106)	−86 (−190; −15)
Supportive care	195 (27)	(0; 4.478)	447 (65)	(0; 16,330)	−252 −1.009; 42)
Other costs	28 (4)	(0; 700)	26 (6)	(0; 1.280)	2 (−60; 31)
Total health care costs	427 (30)	(18; 4.914)	820 (74)	(0; 17,597)	−393 (−1.179; −45)
Total societal costs	455 (32)	(18; 5.256)	846 (79)	(0; 18,877)	−392 (−1.254; −26)

Table 3. Results of the cost-effectiveness analysis, cost-utility analysis and sensitivity analyses with respect to primary outcomes (QALYs). Note: N: number of observations in the analysis; ΔC: difference in costs; ΔE: difference in effects; 95% CI: 95% confidence interval; ICER: Incremental cost-effectiveness ration; NE: northeast; SE, southwest; SW: southwest; NW: northwest; pCE: probability that the intervention is cost-effective as compared to usual care; QALY: quality-adjusted life-year;*adjusted for education. All costs are presented in €.

Outcome	N	ΔC (95% CI)	ΔE (95% CI)	ICER	NE	SE	SW	NW	pCE	pCE	pCE
									0	20,000	80,000
Main analysis*
People with MCI/dementia
QALY	150	−542 (−2.386; 1.301)	−0.001 (–0.007; 0.005)	541,503	7	29	42	22	0.72	0.71	0.67
Caregivers
QALY	150	−401 (−946; 143)	0.003 (–0.001; 0.008)	−115,649	5	89	5	1	0.93	0.95	0.98
SA1: Unadjusted analysis
People with MCI/dementia
QALY	150	−774 (–2.683; 1.136)	−0.001 (-0.006; 0.005)	1,278,509	5	36	42	16	0.79	0.78	0.75
Caregivers
QALY	150	−392 (–928; 145)	0.003 (−0.001; 0.008)	−116,072	5	89	6	1	0.92	0.95	0.97
SA2: Healthcare perspective*
People with MCI/dementia
QALY	150	−459 (–1.627; 708)	−0.001 (–0.006; 0.005)	759,043	5	37	42	17	0.78	0.77	0.72
Caregivers
QALY	150	−402 (–912; 107)	0.003 (–0.001; 0.008)	−115,961	4	91	5	0	0.94	0.96	0.98
SA3: Costs merged together*
QALY	150	−1353 (–3.630; 924)	0.002 (–0.005; 0.009)	−728,592	7	62	25	6	0.88	0.88	0.88
SA4: Complete-case analysis*
People with MCI/dementia
QALY	114	301 (−2.380; 2.983)	−0.001 (–0.009; 0.007)	−432,448	20	22	18	39	0.41	0.41	0.41
Caregivers
QALY	115	−77 (–422; 268)	0.004 (–0.002; 0.009)	−19,767	28	64	4	4	0.67	0.78	0.88
SA5: Excluding outliers*
People with MCI/dementia
QALY	136	−1.258 (–2.956; 440)	−0.001 (–0.007; 0.005)	1470,365	1	37	55	6	0.93	0.92	0.89
Caregivers
QALY	140	−1.524 (−2.649; −400)	0.003 (–0.002; 0.007)	−586,584	0	88	12	0	1	1	1

Table 4. Results of the cost-effectiveness analysis, cost-utility analysis and sensitivity analyses with respect to secondary outcome. Note: N: number of observations in the analysis; ΔC: difference in costs; ΔE: difference in effects; 95% CI, 95% confidence interval; ICER: Incremental cost-effectiveness ratio; NE: northeast; SE: southwest; SW: southwest; NW, northwest; pCE: probability that the intervention is cost-effective as compared to usual care at willingness to pay thresholds listed in bld (€per point of improvement); QALY, quality-adjusted life-year; MSPP-d: MSPP total diversity score; MSPP-f: MSPP total frequency score;*adjusted for education. All costs are presented in €.

Outcome	N	ΔC (95% CI)	ΔE (95% CI)	ICER	NE	SE	SW	NW	pCE	pCE	pCE
Main analysis: Societal perspective*
People with MCI/dementia
									0	20,000	80,000
ASCOT	150	−542 (−2.392; 1307)	0.008 (−0.046; 0.062)	−69,256	18	45	26	11	0.72	0.73	0.68
									0	750	3,000
MSPP-d.	150	−542 (−2.383; 1.298)	0.663 (−0.963; 2.289)	−818	23	56	15	6	0.72	0.82	0.83
MSPP-f.	150	−542 (−2396; 1.311)	−0.006 (−0.441; 0.429)	84,588	13	35	36	15	0.72	0.71	0.65
Caregivers
SSCQ	150	−401 (−940; 138)	0.795 (0.145; 1.446)	−505	5	94	0	0	0.93	1	1
SA1: Unadjusted analysis
People with MCI/dementia
									0	20,000	80,000
ASCOT	150	−774 (−2.676; 1.129)	0.006 (−0.048; 0.059)	−139,445	12	47	32	9	0.79	0.78	0.69
									0	750	3,000
MSPP-d.	150	−774 (−2.680; 1.132)	0.681 (−0.959; 2.322)	−1,135	17	63	16	4	0.79	0.87	0.84
MSPP-f.	150	−774 (−2.668; 1121)	0.003 (−0.426; 0.432)	−288,932	10	40	39	11	0.79	0.78	0.74
Caregivers
SSCQ	150	−392 (−927; 143)	0.792 (0.141; 1.442)	−495	5	94	0	0	0.92	1	1
SA2: Healthcare perspective*
People with MCI/dementia
									0	20,000	80,000
ASCOT	150	−459 (−1.624; 705)	0.006 (−0.048; 0.059)	−82,788	12	47	31	9	0.78	0.75	0.65
									0	750	3,000
MSPP-d.	150	−459 (−1.624; 705)	0.681 (−0.959; 2.322)	−674	18	62	16	4	0.78	0.87	0.84
MSPP-f.	150	−459 (-−1.623; 705)	0.003 (−0.425; 0.43)	−171,537	11	39	39	11	0.78	0.77	0.77
Caregivers
SSCQ	150	−402 (−911; 107)	0.795 (0.146; 1.445)	−506	4	95	0	0	0.94	1	1
SA4: Complete-case analysis*
People with MCI/dementia
									0	20,000	80,000
ASCOT	108	187 (−2.540; 2,914)	0.009 (−0.045; 0.062)	21,750	36	27	17	20	0.45	0.50	0.58
									0	750	3,000
MSPP-d.	103	959 (−1.804; 3,721)	0.127 (−1.841; 2.094)	7,575	41	14	11	35	0.25	0.3	0.43
MSPP-f.	103	959 (−1.804; 3,721)	−0.104 (−0.596; 0.387)	−9,198	25	9	16	51	0.25	0.24	0.22
Caregivers
SSCQ	115	−77 (−422; 268)	0.885 (0.218; 1.552)	−87	32	67	0	0	0.67	0.99	1
SA5: Excluding outliers*
People with MCI/dementia
									0	20,000	80,000
ASCOT	136	−1,258 (−2.963; 448)	0.009 (−0.048; 0.066)	−140,489	4	57	36	3	0.92	0.91	0.78
									0	750	3,000
MSPP-d.	136	−1,258 (−2.964; 449)	0.804 (−0.898; 2.505)	−1.565	6	77	16	1	0.93	0.96	0.91
MSPP-f.	136	−1,258 (−2.957; 441)	0.033 (−0.409; 0.474)	−38,259	4	52	41	3	0.92	0.91	0.86
Caregivers
SSCQ	140	−1,510 (−2/.655; −366)	0.757 (0.101; 1.413)	−1,995	0	99	1	0	1	1	1

Data availability statement

The data that support the findings of this study are available from the corresponding author, DN, upon reasonable request.