Cost-effectiveness of a multicomponent primary care program targeting frail elderly people

Franca G H Ruikes, Eddy M Adang, Willem J J Assendelft, Henk J Schers, Raymond T C M Koopmans, Sytse U Zuidema, Franca G H Ruikes, Eddy M Adang, Willem J J Assendelft, Henk J Schers, Raymond T C M Koopmans, Sytse U Zuidema

Abstract

Background: Over the last 20 years, integrated care programs for frail elderly people aimed to prevent functional dependence and reduce hospitalization and institutionalization. However, results have been inconsistent and merely modest. To date, evidence on the cost-effectiveness of these programs is scarce. We evaluated the cost-effectiveness of the CareWell program, a multicomponent integrated care program for frail elderly people.

Methods: Economic evaluation from a healthcare perspective embedded in a cluster controlled trial of 12 months in 12 general practices in (the region of) Nijmegen. Two hundred and four frail elderly from 6 general practices in the intervention group received care according to the CareWell program, consisting of multidisciplinary team meetings, proactive care planning, case management, and medication reviews; 165 frail elderly from 6 general practices in the control group received usual care. In cost-effectiveness analyses, we related costs to daily functioning (Katz-15 change score i.e. follow up score minus baseline score) and quality adjusted life years (EQ-5D-3 L).

Results: Adjusted mean costs directly related to the intervention were €456 per person. Adjusted mean total costs, i.e. intervention costs plus healthcare utilization costs, were €1583 (95% CI -4647 to 1481) higher in the intervention group than in the control group. Incremental Net Monetary Benefits did not show significant differences between groups, but on average tended to favour usual care.

Conclusions: The CareWell primary program was not cost-effective after 12 months. From a cost-effectiveness perspective, widespread implementation of the program in its current form cannot be recommended.

Trial registration: The study was registered in the ClinicalTrials.govProtocol Registration System: ( NCT01499797 ; December 26, 2011). Retrospectively registered.

Keywords: Activities of daily living; Cost-benefit analysis; Delivery of health care; Frail elderly; Integrated; Primary health care.

Conflict of interest statement

Ethics approval and consent to participate

The study was reviewed by the Ethics Committee of the Radboud University Medical Centre Nijmegen (registration number 2010/403). All participants gave written informed consent. In case of cognitive deficits, both the participant and their primary caregiver/ legal representative consented.

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
Flow diagram of participants
Fig. 2
Fig. 2
Incremental net monetary benefits (in Euros) against WTP for Katz-15 change score* and QALY. Upper panels show the incremental net monetary benefits (in formula: iNMB = (WTP * ∆ effects) – ∆ costs) against WTP for Katz-15 change scores; lower panels show iNMBs against WTP for QALY. All iNMBs are negative, i.e. the intervention does not provide value for money compared to usual care (not significant). Sensitivity analyses, excluding medication costs, underline the results (right panels)WTP = Willingness to Pay. QALY = Quality Adjusted Life Year, derived from the EQ-5D-3 L, based on the Dutch tariff [29] using the trapezium rule.* Improvement on the Katz-15 change score is indicated by a lower score, meaning less functional decline regarding (instrumental) activities of daily living

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