Occupational therapy compared with social work assessment for older people. An economic evaluation alongside the CAMELOT randomised controlled trial

Objectives: To compare costs and outcome of occupational therapy-led assessment with social worker-led assessment of older people, in terms of their independence and quality of life. Design: Cost-effectiveness analysis alongside a randomised controlled trial. The analysis took viewpoints of health services and patients. The primary outcome measure for cost-effectiveness was dependency using the Community Dependency Index (CDI). Secondary outcomes included utility scores based on the EuroQoL (EQ-5D). Resource use was measured for each patient, from clinical records and from patient carer interviews at 8 months. Unit costs of health and social care resources were derived from local sources and national datasets. Cost-effectiveness was analysed using cost-effectiveness acceptability curves. Results: There were no differences between the two arms of the trial in terms of cost-effectiveness. There is an apparent increase in mean cost per case for the occupational therapy arm but this is not statistically significant (mean difference in cost per case £542, 95% CI £434-1,519). Mean total costs of care per participant were £4,379 and £3,837 for the occupational therapy and social work arms, respectively. At best the intervention would improve outcomes at a cost of £14,000 per quality-adjusted life year (QALY). The probability of such an outcome was <50%. Conclusions: From a policy perspective, the lack of difference in clinical and cost-effectiveness means that either a social work or an occupational therapy service is successful in making care assessments that enable an older person to remain in their own home.