Cost-effectiveness of outpatient geriatric assessment with an intervention to increase adherence.
BACKGROUND
Comprehensive geriatric assessment (CGA) can be effective in inpatient units, but such inpatient settings are prohibitively expensive. If similar benefits could be obtained in outpatient settings, CGA might be a more attractive option.


OBJECTIVE
To assess the cost-effectiveness (CE) of an outpatient geriatric assessment with an intervention to increase adherence.


METHODS
Three hundred fifty-one community-dwelling, elderly subjects with at least one of four geriatric conditions.


METHODS
In addition to the measures of functioning, we collected data on the costs of the intervention itself and on the use of medical services in the 64 weeks after the intervention.


RESULTS
The intervention, which prevented functional decline, cost $273 per participant. The intervention group averaged three more visits than the control group in the first 32 weeks after the intervention, but only 1.2 extra visits in the next 32 weeks. We estimate that the costs of these additional medical services would be $473 for the 5 years after the intervention, leading to a total cost per Quality Adjusted Life Year (QALY) of $10,600.


CONCLUSIONS
The CE of this program compares favorably with many common medical interventions. Whether investments should be made in health care resources on treatments that lead to modest improvements in the functioning of community-dwelling elderly people remains a societal decision.
Keeler
E B
EB
RAND Health, Santa Monica, CA 90407-2138, USA. emmett@rand.org
Robalino
D A
DA
Frank
J C
JC
Hirsch
S H
SH
Maly
R C
RC
Reuben
D B
DB
D000203:Activities of Daily Living; D000368:Aged; D000553:Ambulatory Care / Q000191:economics* / Q000523:psychology* / Q000706:statistics & numerical data; D003191:Comprehensive Health Care / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D015577:Geriatric Assessment; D006302:Health Services Research; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D014481:United States