Journal
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
Volume 63, Issue 12, Pages 2494-2504Publisher
WILEY
DOI: 10.1111/jgs.13834
Keywords
economic evaluation; frail older adults; primary care; integrated care; stepped-wedge randomized controlled trial
Categories
Funding
- The Netherlands Organization for Health Research and Development: Dutch National Care for Elderly Program [311080201]
Ask authors/readers for more resources
ObjectivesTo evaluate the cost-effectiveness of the Geriatric Care Model (GCM), an integrated care model for frail older adults based on the Chronic Care Model, with that of usual care. DesignEconomic evaluation alongside a 24-month stepped-wedge cluster-randomized controlled trial. SettingPrimary care (35 practices) in two regions in the Netherlands. ParticipantsCommunity-dwelling older adults who were frail according to their primary care physicians and the Program on Research for Integrating Services for the Maintenance of Autonomy case-finding tool questionnaire (N=1,147). InterventionThe GCM consisted of the following components: a regularly scheduled in-home comprehensive geriatric assessment by a practice nurse followed by a customized care plan, management and training of practice nurses by a geriatric expert team, and coordination of care through community network meetings and multidisciplinary team consultations of individuals with complex care needs. MeasurementsOutcomes were measured every 6months and included costs from a societal perspective, health-related quality of life (Medical Outcomes Study 12-item Short-Form Survey (SF-12) physical (PCS) and mental component summary (MCS) scales), functional limitations (Katz activities of daily living and instrumental activities of daily living), and quality-adjusted life years based on the EQ-5D. ResultsMultilevel regression models adjusted for time and baseline confounders showed no significant differences in costs ($356, 95% confidence interval=-$488-1,134) and outcomes between intervention and usual care phases. Cost-effectiveness acceptability curves showed that, for the SF-12 PCS and MCS, the probability of the intervention being cost-effective was 0.76 if decision-makers are willing to pay $30,000 per point improvement on the SF-12 scales (range 0-100). For all other outcomes the probability of the intervention being cost-effective was low. ConclusionBecause the GCM was not cost-effective compared to usual care after 24months of follow-up, widespread implementation in its current form is not recommended.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available