Cost‐Effectiveness of a Chronic Care Model for Frail Older Adults in Primary Care: Economic Evaluation Alongside a Stepped‐Wedge Cluster‐Randomized Trial

Leeuwen, Karen M van; Bosmans, Judith E.; Jansen, A.P.D.; Hoogendijk, Emiel O.; Muntinga, Maaike; Hout, Hein van; Nijpels, Giel; Horst, Henriëtte E. van der; Tulder, Maurits W. van

doi:10.1111/jgs.13834

Cited by 56 publications

(77 citation statements)

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“…[19] Recent studies in the Netherlands and Finland which were performed from a societal perspective, found no evidence for the cost-effectiveness of multifactorial preventive interventions in preventing or postponing new disabilities as compared with usual care. [13–16, 48] This is consistent with the results of our study. Two other recent studies which were performed from a societal perspective, found that their intervention was cost-effective at high willingness to pay ratios (EUR 20,000 and 50,000 Australian dollars (= EUR 32,327) respectively).…”

Section: Discussionsupporting

confidence: 93%

“…A large variety consists between the total cost per participant over a one-year period between different studies in the intervention group (the estimated total amounts vary between EUR 13,251 and EUR 19,353). [15, 48] The total cost per participant described in our study are substantially lower than the total costs described in these other studies. This may have resulted from the exclusion of informal care cost in our study.…”

Section: Discussioncontrasting

confidence: 67%

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

et al. 2017

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ObjectiveTo 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.MethodsWe 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.ResultsThere 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.ConclusionThe 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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Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 67%

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

et al. 2017

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“…No effects were found on "hard" outcomes, such as hospital admissions No effects on quality of life (SF-12), health-related quality of life, functional limitations, self-rated health, psychological well-being, social functioning and hospitalisations [10]. The intervention is not costeffective [13].…”

Section: Results From Three Recent Studies In the Netherlandsmentioning

confidence: 99%

“…It should be noted that both the ACT trial and the U-PROFIT trial found a small effect of the intervention on functional limitations (IADL or a combined ADL/IADL measure), but the effects were not statistically significant after correction for multiple comparisons (ACT) [10], or the effect size was very small and not clinically relevant (U-PROFIT) [12]. The interventions of the ACT trial and the PoC trial were not cost-effective compared with usual care [13,14]. The intervention of the U-PROFIT trial had a small likelihood of being cost-effective, but only with large willingness to pay values.…”

Section: E O Hoogendijkmentioning

confidence: 99%

How effective is integrated care for community-dwelling frail older people? The case of the Netherlands

Hoogendijk¹

2016

Age Ageing

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Integrated care programs have been developed to enhance the quality care for older adults in primary care. These programs usually consist of a multidisciplinary approach, with personalised care based on comprehensive geriatric assessments. However, there is limited evidence for the effectiveness of these programs in frail older people. In this article, we review the results of three recent intervention studies carried out as part of the Dutch National Care for the Elderly Programme. The results illustrate how difficult it is to improve outcomes in community-dwelling frail older adults by means of integrated care. Furthermore, we discuss the implications of these studies for future research into frailty interventions.

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“…However, so far the evidence on the effectiveness of integrated care for people with geriatric conditions has been mixed. While some interventions were found to have contributed to a reduction in symptoms, emergency department visits, acute hospital admissions and hospital bed days [19, 20], other interventions showed no improvements in length of hospital stay, use of care, prevention of adverse outcomes, health status and costs [20–25]. In addition to this heterogeneity in outcomes, there was also a considerable variation in the interventions themselves, which ranged from telehealth education, discharge planning and community support, and multidisciplinary pathways to integration of acute, chronic and social care.…”

Section: Introductionmentioning

confidence: 99%

Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved

Busetto

Kiselev

Steinhagen‐Thiessen

et al. 2017

BMC Health Serv Res

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BackgroundMany health systems have implemented integrated care as an alternative approach to health care delivery that is more appropriate for patients with complex, long-term needs. The objective of this article was to analyse the implementation of integrated care at a German geriatric hospital and explore whether the use of a “context-mechanisms-outcomes”-based model provides insights into when and why beneficial outcomes can be achieved.MethodsWe conducted 15 semi-structured interviews with health professionals employed at the hospital. The data were qualitatively analysed using a “context-mechanisms-outcomes”-based model. Specifically, mechanisms were defined as the different components of the integrated care intervention and categorised according to Wagner’s Chronic Care Model (CCM). Context was understood as the setting in which the mechanisms are brought into practice and described by the barriers and facilitators encountered in the implementation process. These were categorised according to the six levels of Grol and Wensing’s Implementation Model (IM): innovation, individual professional, patient, social context, organisational context and economic and political context. Outcomes were defined as the effects triggered by mechanisms and context, and categorised according to the six dimensions of quality of care as defined by the World Health Organization, namely effectiveness, efficiency, accessibility, patient-centeredness, equity and safety.ResultsThe integrated care intervention consisted of three main components: a specific reimbursement system (“early complex geriatric rehabilitation”), multidisciplinary cooperation, and comprehensive geriatric assessments. The inflexibility of the reimbursement system regarding the obligatory number of treatment sessions contributed to over-, under- and misuse of services. Multidisciplinary cooperation was impeded by a high workload, which contributed to waste in workflows. The comprehensive geriatric assessments were complemented with information provided by family members, which contributed to decreased likelihood of adverse events.ConclusionsWe recommend an increased focus on trying to understand how intervention components interact with context factors and, combined, lead to positive and/or negative outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2105-7) contains supplementary material, which is available to authorized users.

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Cost‐Effectiveness of a Chronic Care Model for Frail Older Adults in Primary Care: Economic Evaluation Alongside a Stepped‐Wedge Cluster‐Randomized Trial

Abstract: Because the GCM was not cost-effective compared to usual care after 24 months of follow-up, widespread implementation in its current form is not recommended.

Cited by 56 publications

References 44 publications

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

How effective is integrated care for community-dwelling frail older people? The case of the Netherlands

Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved

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