Cost‐effectiveness of clinical interventions for delirium: A systematic literature review of economic evaluations

Abstract

Objective Little is known about the economic value of clinical interventions for delirium. This review aims to synthesise and appraise available economic evidence, including resource use, costs, and cost‐effectiveness of interventions for reducing, preventing, and treating delirium. Methods Systematic review of published and grey literature on full and partial economic evaluations. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Results Fourteen economic evaluations (43% full, 57% partial) across nine multicomponent and nonpharmacological intervention types met inclusion criteria. The intervention costs ranged between US$386 and $553 per person in inpatient settings. Multicomponent delirium prevention intervention and the Hospital Elder Life Program (HELP) reported statistically significant cost savings or cost offsets somewhere else in the health system. Cost savings related to inpatient, outpatient, and out‐of‐pocket costs ranged between $194 and $6022 per person. The average CHEERS score was 74% (±SD 10%). Conclusion Evidence on a joint distribution of costs and outcomes of delirium interventions was limited, varied and of generally low quality. Directed expansion of health economics towards the evaluation of delirium care is necessary to ensure effective implementation that meets patients' needs and is cost‐effective in achieving similar or better outcomes for the same or lower cost.

One‐year Medicare costs associated with delirium in older hospitalized patients with and without Alzheimer's disease dementia and related disorders

“…Our study shows increased costs of $34,828 (adjusted mean difference) in delirious patients with ADRD. These costs are comparatively higher than those in Kinchin et al.’s systematic review in which, after adjusting for inflation, the additional costs attributable to delirium were $806 to $24,509 per patient per year 49 . Notably, Kinchin et al.’s study included only non‐ADRD populations (surgical, medical, oncology).…”

“…Thus, our study demonstrated potentially increased costs of delirium in persons with dementia, compared to those without dementia. Given the known effectiveness of multicomponent delirium prevention strategies, such as the Hospital Elder Life Program, 9,48,49 at least some of these costs may be preventable. The present study provides a nuanced examination of some of the health‐care costs associated with caring for ADRD patients.…”

“…These costs are comparatively higher than those in Kinchin et al's systematic review in which, after adjusting for inflation, the additional costs attributable to delirium were $806 to $24,509 per patient per year. 49 Notably, Kinchin et al's study included only non-ADRD populations (surgical, medical, oncology). Thus, our study demonstrated potentially increased costs of delirium in persons with dementia, compared to those without dementia.…”

Beyond confusion: Embedding psychiatry in delirium research and clinical practice

“…One reason for this is the absence of effective pharmacological treatments, and the potentially high costs of non‐pharmacological or multicomponent alternatives. Kinchin et al 7 reviewed economic evaluations of delirium interventions. Evidence for cost‐effectiveness was sparse, and the most evaluated interventions were for delirium prevention.…”