What price an additional day of life? A cost-effectiveness study of case management.
OBJECTIVE
To examine the costs and benefits of a case-management program for an elderly, functionally impaired population in a managed care setting.


METHODS
A post hoc, cost-effectiveness study of case management.


METHODS
As part of a larger study, 317 elderly, functionally impaired clients were randomly assigned to a case-managed or regular-care group. During the 2-year study period, 34 clients in the case-managed and 43 clients in the regular-care group died. A post hoc analysis of the difference in average total cost per person, death rates, and average number of days of exposure per person were assessed to determine the cost per life saved and cost per additional day of life.


RESULTS
Although the average costs for the case-managed group were greater than the costs for the regular-care group, clients in the case-managed group lived an average of 106 days longer. The cost per additional day of life was $40. The difference in death rates was so small that, by extrapolation, the cost per life saved was over $42 million.


CONCLUSIONS
Although the case-management program was more costly when viewed from a purely fiscal perspective, it may very well be considered a success when its benefits are evaluated. The case-management program improved quality and was associated with prolonged life at a cost of $40 per day of additional life. Additional research involving other patient populations, study settings, and case-management models is warranted.
Long
M J
MJ
Department of Public Health Sciences, Wichita State University, USA. long@chp.twsu.edu
Marshall
B S
BS
D000368:Aged; D019090:Case Management / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003627:Data Interpretation, Statistical; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D017146:Models, Organizational; D010865:Pilot Projects; D014481:United States; D026712:Value of Life