Cost-effectiveness of a multidisciplinary intervention model for community-dwelling frail older people.
BACKGROUND
There is growing interest in geriatric care for community-dwelling older people. There are, however, relatively few reports on the economics of this type of care. This article reports about the cost-effectiveness of the Dutch Geriatric Intervention Program (DGIP) compared to usual care in frail older people at 6-month follow-up from a health care system's point of view.


METHODS
We conducted this economic evaluation in an observer-blind randomized controlled trial (Dutch EASYcare Study: ClinicalTrials.gov Identifier NCT00105378). Difference in treatment effect was calculated as the difference in proportions of successfully treated patients (prevented functional decline accompanied by improved well-being). Incremental treatment costs were calculated as the difference in mean total care costs. The incremental cost-effectiveness ratio (ICER) was expressed as total cost per successful treatment. Bootstrap methods were used to determine confidence intervals (CI) for these measures.


RESULTS
The average cost of the intervention under study (DGIP) was 998 euros (95% CI, 888-1108). The increment in total cost resulting from DGIP was a little over 761 euros (-3336 to 4687). Hospitalization and institutionalization costs were less; home care, adult day care, and meals-on-wheels costs were higher. There was a significant difference in proportions of successful treatments of 22.3% (4.3-41.4). The number needed to treat was approximately 4.7 (2.3-18.0). The ICER is 3418 euros per successful treatment (-21,458 to 45,362). The new treatment is cost-effective at a willingness-to-pay of 34,000 euros.


CONCLUSIONS
The results of this economic evaluation suggest that DGIP is an effective addition to primary care for frail older people at a reasonable cost.
Melis
René J F
RJ
Radboud University Nijmegen Medical Centre, Department of Geriatric Medicine, Nijmegen, The Netherlands. r.melis@ger.umcn.nl
Adang
Eddy
E
Teerenstra
Steven
S
van Eijken
Monique I J
MI
Wimo
Anders
A
van Achterberg
Theo
T
van de Lisdonk
Eloy H
EH
Rikkert
Marcel G M Olde
MG
D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000191:economics; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D017059:Models, Econometric; D008962:Models, Theoretical; D009426:Netherlands; D010348:Patient Care Team; D016037:Single-Blind Method