title: Cost-effectiveness of multi-component interventions to prevent delirium in older people admitted to medical wards.
abstract: BACKGROUND
  there is evidence to suggest that delirium incidence can be reduced in older people admitted to medical services using multi-component interventions that target delirium risk factors. The cost-effectiveness of this approach is uncertain. We therefore developed a novel cost-effectiveness model for delirium prevention.
  
  
  METHODS
  we compared multi-component delirium prevention intervention with usual care using a model based on a decision tree analysis. The model was used to estimate the incremental net monetary benefit (INMB). The robustness of the cost-effectiveness result was explored using deterministic and probabilistic sensitivity analyses.
  
  
  RESULTS
  the multi-component prevention intervention was cost-effective when compared with usual care. It was associated with an INMB of £2,200 using a cost-effectiveness threshold of £20,000 per quality-adjusted life year (QALY). It remained cost-effective in the majority of the deterministic sensitivity analyses and was cost-effective in 96.8% of the simulations carried out in the probabilistic sensitivity analysis.
  
  
  CONCLUSIONS
  our analysis has shown convincingly that multi-component prevention interventions for delirium should be considered as a cost-effective health-care strategy for medically ill people admitted to hospital. It is an attractive intervention for health-care planners as they strive to reconfigure their services to better meet the needs of an ageing population.
authors.affiliation: KSG-Trans Ltd., 35 Hengrove Close, Headington, Oxford, UK. akunneaf@netscape.net
authors.forename: Anayo
authors.initials: A
authors.lastname: Akunne
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Murthy
authors.forename: John
authors.initials: J
authors.lastname: Young
mesh_terms: D000367:Age Factors; D000368:Aged; D000375:Aging; D003198:Computer Simulation; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003693:Delirium / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control*; D005853:Geriatrics / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D007297:Inpatients; D053208:Kaplan-Meier Estimate; D008017:Life Expectancy; D018803:Models, Economic; D016017:Odds Ratio; D010343:Patient Admission / Q000191:economics*; D010348:Patient Care Team / Q000191:economics*; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome