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Randomized Controlled Trial
. 2018 Jan 31;18(1):32.
doi: 10.1186/s12877-017-0703-1.

Cost-effectiveness of comprehensive geriatric assessment at an ambulatory geriatric unit based on the AGe-FIT trial

Martina Lundqvist  1 , Jenny Alwin  2 , Martin Henriksson  2 , Magnus Husberg  2 , Per Carlsson  2 , Anne W Ekdahl  3   4
Affiliations
Randomized Controlled Trial

Cost-effectiveness of comprehensive geriatric assessment at an ambulatory geriatric unit based on the AGe-FIT trial

Martina Lundqvist et al. BMC Geriatr. .

Abstract

Background: Older people with multi-morbidity are increasingly challenging for today's healthcare, and novel, cost-effective healthcare solutions are needed. The aim of this study was to assess the cost-effectiveness of comprehensive geriatric assessment (CGA) at an ambulatory geriatric unit for people ≥75 years with multi-morbidity.

Method: The primary outcome was the incremental cost-effectiveness ratio (ICER) comparing costs and quality-adjusted life years (QALYs) of a CGA strategy with usual care in a Swedish setting. Outcomes were estimated over a lifelong time horizon using decision-analytic modelling based on data from the randomized AGe-FIT trial. The analysis employed a public health care sector perspective. Costs and QALYs were discounted by 3% per annum and are reported in 2016 euros.

Results: Compared with usual care CGA was associated with a per patient mean incremental cost of approximately 25,000 EUR and a gain of 0.54 QALYs resulting in an ICER of 46,000 EUR. The incremental costs were primarily caused by intervention costs and costs associated with increased survival, whereas the gain in QALYs was primarily a consequence of the fact that patients in the CGA group lived longer.

Conclusion: CGA in an ambulatory setting for older people with multi-morbidity results in a cost per QALY of 46,000 EUR compared with usual care, a figure generally considered reasonable in a Swedish healthcare context. A rather simple reorganisation of care for older people with multi-morbidity may therefore cost effectively contribute to meet the needs of this complex patient population.

Trial registration: The trial was retrospectively registered in clinicaltrial.gov, NCT01446757 . September, 2011.

Keywords: Ambulatory care; Comprehensive geriatric assessment; Cost-effectiveness; Multi-morbidity; Quality-adjusted life years.

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Conflict of interest statement

Ethics approval and consent to participate

The AGe-FIT trial was approved by the regional ethical vetting board at Linköping University (No: 2011/41–31 and No: 2015/6–32), and is registered on clinicaltrials.gov (NCT01446757). All participants gave written informed consent to participate in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Results of probabilistic analysis. a Cost-effectiveness plane based on 10,000 iterations illustrating the distribution of the ICER. b Cost-effectiveness acceptability curves showing the probability that CGA is cost-effective at different thresholds for cost-effectiveness
See this image and copyright information in PMC

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References

    1. SBU. Comprehensive geriatric assessment and care for frail elderly. Stockholm: Swedish Council on Health Technology Assessment (SBU); 2014. SBU report no 221 (in Swedish).
    1. Wieland D, Hirth V. Comprehensive geriatric assessment. Cancer Control. 2003;10:454–462. doi: 10.1177/107327480301000603. - DOI - PubMed
    1. Ellis G, Whitehead MA, O'Neill D, Langhorne P, Robinson D. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2011;(7):CD006211. - PMC - PubMed
    1. Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, et al. Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet. 2015;385:1623–1633. doi: 10.1016/S0140-6736(14)62409-0. - DOI - PubMed
    1. Melis R, Adang E, Teerenstra S, van Eijken M, Wimo A, Tv A, et al. multidimensional geriatric assessment: back to the future cost-effectiveness of a multidisciplinary intervention model for community-dwelling frail older people. J Gerontol A Biol Sci Med Sci. 2008;63:275–282. doi: 10.1093/gerona/63.3.275. - DOI - PubMed

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