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Randomized Controlled Trial
. 2017 Apr 17;12(4):e0175272.
doi: 10.1371/journal.pone.0175272. eCollection 2017.

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  1 , Janet L MacNeil-Vroomen  2 , Marjon van Rijn  2 , Bianca M Buurman  2 , Sophia E de Rooij  2   3 , Eric P Moll van Charante  1 , Judith E Bosmans  4
Affiliations
Randomized Controlled Trial

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 et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow of practices and participants through the trial.
Eleven practices were randomized to the intervention group and 13 practices were randomized to the usual care group. In both groups around 35% of the invited persons were at increased risk of functional decline and participated in the study. In both groups the follow-up rates were around 77% after one year respectively.
Fig 2
Fig 2. Cost-Effectiveness (CE) Planes for disability.
The cost-effectiveness (CE) planes visualize the uncertainty surrounding the ICER estimated using bootstrapped bivariate regression models while adjusting for confounders. Modified Katz-Activities of daily living index score: (range 0–15). The effect difference was multiplied by -1 to keep the CE plane understandable (northeast: more effective, more expensive; southeast: more effective, less expensive; southwest: less effective, less expensive; northwest: less effective, more expensive).
Fig 3
Fig 3. Cost-effectiveness acceptability curves (CEAC) for disability.
The CEAC is a plot of the probability that the intervention is cost-effective in comparison with usual care (y-axis) as a function of the money society might be willing to pay for one additional unit of outcome (x-axis) Modified Katz-Activities of daily living index score
Fig 4
Fig 4. Cost-Effectiveness (CE) Planes for QALY.
Qaly = Quality-adjusted-life-year: (range -0.33–1.0) positive results indicate improvement in QALY
Fig 5
Fig 5. Cost-effectiveness acceptability curves (CEAC) for disability.
Qaly = Quality-adjusted-life-year
See this image and copyright information in PMC

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