Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct;53(5):3471-3494.
doi: 10.1111/1475-6773.12853. Epub 2018 Mar 24.

Integrated and Person-Centered Care for Community-Living Older Adults: A Cost-Effectiveness Study

Ronald J Uittenbroek  1 , Antoinette D I van Asselt  2   3 , Sophie L W Spoorenberg  1 , Hubertus P H Kremer  4 , Klaske Wynia  1   4 , Sijmen A Reijneveld  1
Affiliations

Integrated and Person-Centered Care for Community-Living Older Adults: A Cost-Effectiveness Study

Ronald J Uittenbroek et al. Health Serv Res. 2018 Oct.

Abstract

Objectives: To assess the cost-effectiveness of Embrace, an integrated primary care service for older adults.

Data sources: Care and support claims from health care insurers, long-term care administration, and municipalities for enrolled older adults between 2011 and 2013.

Study design: A total of 1,456 older adults, listed with 15 general practitioners practices in the Netherlands, were stratified into risk profiles ("Robust," "Frail," and "Complex care needs") and randomized to Embrace or care-as-usual groups. Incremental costs were calculated per quality-adjusted life year, per day able to age in place, and per percentage point risk profile improvement.

Principal findings: Total average costs were higher for Embrace compared to care-as-usual. Differences in health-associated outcomes were small and not statistically significant. Probabilities that Embrace is cost-effective were below 80 percent, except for "risk profile improvements" within risk profile "Complex care needs." Complete case analysis resulted in smaller differences in total average costs across conditions and differences in health-associated outcomes remained small.

Conclusions: According to current standards, Embrace is not considered cost effective after 12 months. However, it could be considered worthwhile in terms of "risk profile improvements" for older adults with "Complex care needs," if society is willing to invest substantially.

Keywords: Cost-effectiveness analysis; integrated care; older adults; primary health care.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow of the Participants
Figure 2
Figure 2
Cost‐effectiveness Planes for Total Sample and Probabilities of Embrace Being Cost Effective [Color figure can be viewed at http://wileyonlinelibrary.com] [Correction added on 11 April 2018, after first online publication: the three graphs in Figure 2 depicting the probabilities of Embrace being cost effective have been corrected for typographical and graphical errors.]
See this image and copyright information in PMC

References

    1. Beswick, A. D. , Rees K., Dieppe P., Ayis S., Gooberman‐Hill R., Horwood J., and Ebrahim S.. 2008. “Complex Interventions to Improve Physical Function and Maintain Independent Living in Elderly People: A Systematic Review and Meta‐analysis.” Lancet 371 (9614): 725–35. - PMC - PubMed
    1. Blom, J. , den Elzen W., van Houwelingen A. H., Heijmans M., Stijnen T., Van den Hout W., and Gussekloo J.. 2016. “Effectiveness and Cost‐effectiveness of a Proactive, Goal‐oriented, Integrated Care Model in General Practice for Older People. A Cluster Randomised Controlled Trial: Integrated Systematic Care for older People‐the ISCOPE study.” Age and Ageing 45 (1): 30–41. - PMC - PubMed
    1. Bloom, D. E. , Chatterji S., Kowal P., Lloyd‐Sherlock P., McKee M., Rechel B., Rosenberg L., and Smith J. P.. 2015. “Macroeconomic Implications of Population Ageing and Selected Policy Responses.” Lancet 385 (9968): 649–57. - PMC - PubMed
    1. Boersma, C. , Broere A., and Postma M. J.. 2010. “Quantification of the Potential Impact of Cost‐Effectiveness Thresholds on Dutch Drug Expenditures Using Retrospective Analysis.” Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research 13 (6): 853–6. - PubMed
    1. Boult, C. , and Wieland G. D.. 2010. “Comprehensive Primary Care for Older Patients with Multiple Chronic Conditions: ‘Nobody Rushes You Through.’” Journal of the American Medical Association 304 (17): 1936–43. - PubMed

Publication types

MeSH terms

LinkOut - more resources