Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: Results of a cluster randomized trial

Jacqueline J Suijker, Janet L MacNeil-Vroomen, Marjon van Rijn, Bianca M Buurman, Sophia E de Rooij, Eric P Moll van Charante, Judith E Bosmans

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

OBJECTIVE: To evaluate the cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people in comparison with usual care.

METHODS: We conducted cost-effectiveness and cost-utility analyses alongside a cluster randomized trial with one-year follow-up. Participants were aged ≥ 70 years and at increased risk of functional decline. Participants in the intervention group (n = 1209) received a comprehensive geriatric assessment and individually tailored multifactorial interventions coordinated by a community-care registered nurse with multiple follow-up visits. The control group (n = 1074) received usual care. Costs were assessed from a healthcare perspective. Outcome measures included disability (modified Katz-Activities of Daily Living (ADL) index score), and quality-adjusted life-years (QALYs). Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated using bootstrapped bivariate regression models while adjusting for confounders.

RESULTS: There were no statistically significant differences in Katz-ADL index score and QALYs between the two groups. Total mean costs were significantly higher in the intervention group (EUR 6518 (SE 472) compared with usual care (EUR 5214 (SE 338); adjusted mean difference €1457 (95% CI: 572; 2537). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.14 at a willingness to pay (WTP) of EUR 50,000 per one point improvement on the Katz-ADL index score and 0.04 at a WTP of EUR 50,000 per QALY gained.

CONCLUSION: The current intervention was not cost-effective compared to usual care to prevent or postpone new disabilities over a one-year period. Based on these findings, implementation of the evaluated multifactorial nurse-led care model is not to be recommended.

Original languageEnglish
Article numbere0175272
Pages (from-to)e0175272
JournalPLoS ONE
Volume12
Issue number4
DOIs
Publication statusPublished - 2017

Keywords

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Cluster Analysis
  • Community Health Nursing
  • Cost-Benefit Analysis
  • Disabled Persons
  • Economics, Nursing
  • Female
  • Geriatric Assessment
  • Health Care Costs
  • Health Services for the Aged
  • Humans
  • Journal Article
  • Male
  • Models, Economic
  • Models, Nursing
  • Netherlands
  • Nursing Care
  • Quality-Adjusted Life Years
  • Randomized Controlled Trial

Fingerprint

Dive into the research topics of 'Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: Results of a cluster randomized trial'. Together they form a unique fingerprint.

Cite this