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Cost-effectiveness of comprehensive geriatric assessment at an ambulatory geriatric unit based on the AGe-FIT trial

Lundqvist, Martina; Alwin, Jenny; Henriksson, Martin; Husberg, Magnus; Carlsson, Per and Ekdahl, Anne W. LU (2018) In BMC Geriatrics 18(1).
Abstract

Background: Older people with multi-morbidity are increasingly challenging for today's healthcare, and novel, cost-effective healthcare solutions are needed. The aim of this study was to assess the cost-effectiveness of comprehensive geriatric assessment (CGA) at an ambulatory geriatric unit for people ≥75 years with multi-morbidity. Method: The primary outcome was the incremental cost-effectiveness ratio (ICER) comparing costs and quality-adjusted life years (QALYs) of a CGA strategy with usual care in a Swedish setting. Outcomes were estimated over a lifelong time horizon using decision-analytic modelling based on data from the randomized AGe-FIT trial. The analysis employed a public health care sector perspective. Costs and QALYs... (More)

Background: Older people with multi-morbidity are increasingly challenging for today's healthcare, and novel, cost-effective healthcare solutions are needed. The aim of this study was to assess the cost-effectiveness of comprehensive geriatric assessment (CGA) at an ambulatory geriatric unit for people ≥75 years with multi-morbidity. Method: The primary outcome was the incremental cost-effectiveness ratio (ICER) comparing costs and quality-adjusted life years (QALYs) of a CGA strategy with usual care in a Swedish setting. Outcomes were estimated over a lifelong time horizon using decision-analytic modelling based on data from the randomized AGe-FIT trial. The analysis employed a public health care sector perspective. Costs and QALYs were discounted by 3% per annum and are reported in 2016 euros. Results: Compared with usual care CGA was associated with a per patient mean incremental cost of approximately 25,000 EUR and a gain of 0.54 QALYs resulting in an ICER of 46,000 EUR. The incremental costs were primarily caused by intervention costs and costs associated with increased survival, whereas the gain in QALYs was primarily a consequence of the fact that patients in the CGA group lived longer. Conclusion: CGA in an ambulatory setting for older people with multi-morbidity results in a cost per QALY of 46,000 EUR compared with usual care, a figure generally considered reasonable in a Swedish healthcare context. A rather simple reorganisation of care for older people with multi-morbidity may therefore cost effectively contribute to meet the needs of this complex patient population. Trial registration: The trial was retrospectively registered in clinicaltrial.gov, NCT01446757. September, 2011.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Ambulatory care, Comprehensive geriatric assessment, Cost-effectiveness, Multi-morbidity, Quality-adjusted life years
in
BMC Geriatrics
volume
18
issue
1
publisher
BioMed Central
external identifiers
  • scopus:85041619008
ISSN
1471-2318
DOI
10.1186/s12877-017-0703-1
language
English
LU publication?
yes
id
1bde41da-6eb2-4b04-9ea1-d776c1721c92
date added to LUP
2018-03-06 11:12:32
date last changed
2018-05-29 10:21:50
@article{1bde41da-6eb2-4b04-9ea1-d776c1721c92,
  abstract     = {<p>Background: Older people with multi-morbidity are increasingly challenging for today's healthcare, and novel, cost-effective healthcare solutions are needed. The aim of this study was to assess the cost-effectiveness of comprehensive geriatric assessment (CGA) at an ambulatory geriatric unit for people ≥75 years with multi-morbidity. Method: The primary outcome was the incremental cost-effectiveness ratio (ICER) comparing costs and quality-adjusted life years (QALYs) of a CGA strategy with usual care in a Swedish setting. Outcomes were estimated over a lifelong time horizon using decision-analytic modelling based on data from the randomized AGe-FIT trial. The analysis employed a public health care sector perspective. Costs and QALYs were discounted by 3% per annum and are reported in 2016 euros. Results: Compared with usual care CGA was associated with a per patient mean incremental cost of approximately 25,000 EUR and a gain of 0.54 QALYs resulting in an ICER of 46,000 EUR. The incremental costs were primarily caused by intervention costs and costs associated with increased survival, whereas the gain in QALYs was primarily a consequence of the fact that patients in the CGA group lived longer. Conclusion: CGA in an ambulatory setting for older people with multi-morbidity results in a cost per QALY of 46,000 EUR compared with usual care, a figure generally considered reasonable in a Swedish healthcare context. A rather simple reorganisation of care for older people with multi-morbidity may therefore cost effectively contribute to meet the needs of this complex patient population. Trial registration: The trial was retrospectively registered in clinicaltrial.gov, NCT01446757. September, 2011.</p>},
  articleno    = {32},
  author       = {Lundqvist, Martina and Alwin, Jenny and Henriksson, Martin and Husberg, Magnus and Carlsson, Per and Ekdahl, Anne W.},
  issn         = {1471-2318},
  keyword      = {Ambulatory care,Comprehensive geriatric assessment,Cost-effectiveness,Multi-morbidity,Quality-adjusted life years},
  language     = {eng},
  month        = {01},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {BMC Geriatrics},
  title        = {Cost-effectiveness of comprehensive geriatric assessment at an ambulatory geriatric unit based on the AGe-FIT trial},
  url          = {http://dx.doi.org/10.1186/s12877-017-0703-1},
  volume       = {18},
  year         = {2018},
}