Abstract
Objective
The objective of this study was to estimate the 3-month within-trial cost-effectiveness
of comprehensive geriatric assessment (CGA) in acute medical care for frail elderly
patients compared to usual medical care, by estimating health-related quality of life
and costs from a societal perspective.
Design
Clinical, prospective, controlled, 1-center intervention trial with 2 parallel groups.
Intervention
Structured, systematic interdisciplinary CGA-based care in an acute elderly care unit.
If the patient fulfilled the inclusion criteria, and there was a bed available at
the CGA unit, the patient was included in the intervention group. If no bed was available
at the CGA unit, the patient was included in the control group and admitted to a conventional
acute medical care unit.
Setting and Participants
A large county hospital in western Sweden. The trial included 408 frail elderly patients,
75 years or older, in need of acute in-hospital treatment. The patients were allocated
to the intervention group (n = 206) or control group (n = 202). Mean age of the patients
was 85.7 years, and 56% were female.
Measures
The primary outcome was the adjusted incremental cost-effectiveness ratio associated
with the intervention compared to the control at the 3-month follow-up.
Results
We undertook cost-effectiveness analysis, adjusted by regression analyses, including
hospital, primary, and municipal care costs and effects. The difference in the mean
adjusted quality-adjusted life years gained between groups at 3 months was 0.0252
[95% confidence interval (CI): 0.0082-0.0422]. The incremental cost, that is, the
difference between the groups, was −3226 US dollars (95% CI: −6167 to −285).
Conclusion
The results indicate that the care in a CGA unit for acutely ill frail elderly patients
is likely to be cost-effective compared to conventional care after 3 months.
Keywords
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Article info
Publication history
Published online: May 18, 2018
Footnotes
The authors declare no conflicts of interest.
This study was funded by grants from the Healthcare Sub-committee, Region Västra Götaland; Department of Research and Development, NU Hospital Group; and the Fyrbodal Research and Development Council, Region Västra Götaland, Sweden.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
