Abstract
© 2017 AMDA – The Society for Post-Acute and Long-Term Care MedicineBackground A proactive integrated approach has shown to preserve daily functioning among older people in the community. The aim is to determine the cost-effectiveness of a proactive integrated primary care program. Methods Economic evaluation embedded in a single-blind, 3-armed, cluster-randomized controlled trial with 12 months’ follow-up in 39 general practices in the Netherlands. General practices were randomized to one of 3 trial arms: (1) an electronic frailty screening instrument using routine medical record data followed by standard general practitioner (GP) care; (2) this screening instrument followed by a nurse-led care program; or (3) usual care. Health resource utilization data were collected using electronic medical records and questionnaires. Associated costs were calculated. A cost-effectiveness analysis from a societal perspective was undertaken. The incremental cost per quality-adjusted life-year was calculated comparing proactive screening arm with usual care, and screening plus nurse-led care arm with usual care, as well as the screening arm with screening plus nurse-led care arm. Results Out of 7638 potential participants, 3092 (40.5%) older adults participated. Whereas effect differences were minor, the total costs per patient were lower in both intervention groups compared with usual care. The probability of cost-effectiveness at €20,000 per QALY threshold was 87% and 91% for screening plus GP care versus usual care and for screening plus nurse-led care compared to usual care, respectively. For screening plus nurse-led care vs screening plus standard GP care, the probability was 55%. Conclusion A proactive screening intervention has a high probability of being cost-effective compared to usual care. The combined intervention showed less value for money.
| Original language | English |
|---|---|
| Pages (from-to) | 1029-1036.e3 |
| Journal | Journal of the American Medical Directors Association |
| Volume | 18 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 1 Dec 2017 |
| Externally published | Yes |
Funding
The Utrecht Proactive Frailty Intervention Trial (U-PROFIT) was supported by a grant from the Netherlands Organization for Health Research and Development (reference 311040201) as part of the National Care for the Elderly Programme. The sponsors approved the study design but were not involved in the data collection, analysis, and interpretation or in writing of the report. The authors had full access to all data as well as the final responsibility for the submission of the manuscript.
| Funders | Funder number |
|---|---|
| National Care for the Elderly Programme | |
| Netherlands Organization for Health Research and Development | 311040201 |