Cost-Effectiveness of a Proactive Primary Care Program for Frail Older People: A Cluster-Randomized Controlled Trial

Bleijenberg, Nienke; Drubbel, Irene; Neslo, Rabin; Schuurmans, Marieke J.; Dam, Valerie H. ten; Numans, Mattijs E.; Wit, G. Ardine de; Wit, Niek J. de

doi:10.1016/j.jamda.2017.06.023

Cited by 32 publications

(43 citation statements)

References 33 publications

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“…The results of this study enhanced our understanding of the treatment fidelity (e.g., how the evidence‐based nurse‐led primary care program was delivered during the trial). The delivery of the care program is probably associated with the obtained trial results that showed a small but significant effect on the preservation of daily functioning (Bleijenberg, Drubbel et al., ). First, the results of this study showed that the nurse‐led intervention program was suboptimally implemented: only one‐third of the older people who reported to have (some) problems at one or more conditions (e.g., cognition or nutrition) did receive further diagnostic assessment.…”

Section: Discussionmentioning

confidence: 99%

“…The effectiveness of this program combined with a frailty screening instrument has been evaluated in a three‐armed cluster randomized trial with over 3,000 older people in the Netherlands. After 1 year of follow‐up, a relatively small, but significant effect on the primary outcome of daily functioning was observed, with beneficial effects for well‐educated older people (Bleijenberg, Drubbel et al., ). Besides an evaluation of the effectiveness, information regarding the delivery of the intervention is required to fully understand how the results were obtained and to facilitate replication.…”

Section: Introductionmentioning

confidence: 99%

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Treatment Fidelity of an Evidence-Based Nurse-Led Intervention in a Proactive Primary Care Program for Older People

Bleijenberg

Dam

Drubbel

et al. 2016

Worldviews on Evidence-Based Nursing

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Background: In a large randomized trial, Utrecht PROactive Frailty Intervention Trial (U-PROFIT), we evaluated the effectiveness of an integrated program on the preservation of daily functioning in older people in primary care that consisted of a frailty identification tool and a multicomponent nurse-led care program. Examination of treatment fidelity is critical to successful translation of evidence-based interventions into practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment Fidelity of an Evidence-Based Nurse-Led Intervention in a Proactive Primary Care Program for Older People

Bleijenberg

Dam

Drubbel

et al. 2016

Worldviews on Evidence-Based Nursing

Self Cite

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“…Three later randomised trials of CGA in the Netherland’s frailty care programme found almost no clinical benefits 31. Available evidence for cost effectiveness is inconsistent and inconclusive 173132…”

Section: Challenges To Adopting the Frailty Agenda In Primary Carementioning

confidence: 99%

The challenge of ageing populations and patient frailty: can primary care adapt?

Reeves

Pye

Ashcroft

et al. 2018

BMJ

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“…Colonoscopy every 10 years No Screening 60-year-old Swedish Lifetime Healthcare 3% EUR (no year) QALYs No All strategies were CE vs no screening SCREESCO study Yes Atkin et al [ 18 ] UK Colorectal cancer 13 different Sttrategies Each other and “no colonoscopy” Individuals with intermediate-grade adenomatous polyps Lifetime NHS 4% 2012–2013 GBP QALYs, ELYs Yes 3-yearly ongoing colonoscopic surveillance without an age cut-off is CE NIHR Yes Baggaley et al [ 75 ] UK HIV INSTI HIV1/HIV2 rapid antibody test Not clear Hackney Borough 40 years NHS 4% 2012 GBP QALYs Yes Screening is CE NHS, NIHR Yes Barzi et al [ 19 ] USA Colorectal cancer 13 screening tools: fecal occult blood test, Flex sig, colonoscopy, CT, DNA. No screening US population 35 years Societal 3% USD (no year) Life years gained No Colonoscopy is CE National Cancer Institute Core Yes Bleijenberg et al [ 13 ] Netherlands Frailty 1. Electronic frailty screening instrument (EFSI) 2.…”

Section: Resultsmentioning

confidence: 99%

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Iragorri

Spackman

2018

Public Health Rev

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BackgroundScreening is an important part of preventive medicine. Ideally, screening tools identify patients early enough to provide treatment and avoid or reduce symptoms and other consequences, improving health outcomes of the population at a reasonable cost. Cost-effectiveness analyses combine the expected benefits and costs of interventions and can be used to assess the value of screening tools.ObjectiveThis review seeks to evaluate the latest cost-effectiveness analyses on screening tools to identify the current challenges encountered and potential methods to overcome them.MethodsA systematic literature search of EMBASE and MEDLINE identified cost-effectiveness analyses of screening tools published in 2017. Data extracted included the population, disease, screening tools, comparators, perspective, time horizon, discounting, and outcomes. Challenges and methodological suggestions were narratively synthesized.ResultsFour key categories were identified: screening pathways, pre-symptomatic disease, treatment outcomes, and non-health benefits. Not all studies included treatment outcomes; 15 studies (22%) did not include treatment following diagnosis. Quality-adjusted life years were used by 35 (51.4%) as the main outcome. Studies that undertook a societal perspective did not report non-health benefits and costs consistently. Two important challenges identified were (i) estimating the sojourn time, i.e., the time between when a patient can be identified by screening tests and when they would have been identified due to symptoms, and (ii) estimating the treatment effect and progression rates of patients identified early.ConclusionsTo capture all important costs and outcomes of a screening tool, screening pathways should be modeled including patient treatment. Also, false positive and false negative patients are likely to have important costs and consequences and should be included in the analysis. As these patients are difficult to identify in regular data sources, common treatment patterns should be used to determine how these patients are likely to be treated. It is important that assumptions are clearly indicated and that the consequences of these assumptions are tested in sensitivity analyses, particularly the assumptions of independence of consecutive tests and the level of patient and provider compliance to guidelines and sojourn times. As data is rarely available regarding the progression of undiagnosed patients, extrapolation from diagnosed patients may be necessary.

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Cost-Effectiveness of a Proactive Primary Care Program for Frail Older People: A Cluster-Randomized Controlled Trial

Abstract: A proactive screening intervention has a high probability of being cost-effective compared to usual care. The combined intervention showed less value for money.

Cited by 32 publications

References 33 publications

Treatment Fidelity of an Evidence-Based Nurse-Led Intervention in a Proactive Primary Care Program for Older People

Treatment Fidelity of an Evidence-Based Nurse-Led Intervention in a Proactive Primary Care Program for Older People

The challenge of ageing populations and patient frailty: can primary care adapt?

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

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