title: Economic evaluation of a multifactorial, interdisciplinary intervention versus usual care to reduce frailty in frail older people.
abstract: OBJECTIVE
  To compare the costs and cost-effectiveness of a multifactorial interdisciplinary intervention versus usual care for older people who are frail.
  
  
  METHODS
  Cost-effectiveness study embedded within a randomized controlled trial.
  
  
  METHODS
  Community-based intervention in Sydney, Australia.
  
  
  METHODS
  A total of 241 community-dwelling people 70 years or older who met the Cardiovascular Health Study criteria for frailty.
  
  
  METHODS
  A 12-month multifactorial, interdisciplinary intervention targeting identified frailty characteristics versus usual care.
  
  
  METHODS
  Health and social service use, frailty, and health-related quality of life (EQ-5D) were measured over the 12-month intervention period. The difference between the mean cost per person for 12 months in the intervention and control groups (incremental cost) and the ratio between incremental cost and effectiveness were calculated.
  
  
  RESULTS
  A total of 216 participants (90%) completed the study. The prevalence of frailty was 14.7% lower in the intervention group compared with the control group at 12 months (95% CI 2.4%-27.0%; P = .02). There was no significant between-group difference in EQ-5D utility scores. The cost for 1 extra person to transition out of frailty was $A15,955 (at 2011 prices). In the "very frail" subgroup (participants met >3 Cardiovascular Health Study frailty criteria), the intervention was both more effective and less costly than the control. A cost-effectiveness acceptability curve shows that the intervention would be cost-effective with 80% certainty if decision makers were willing to pay $A50,000 per extra person transitioning from frailty. In the very frail subpopulation, this reduced to $25,000.
  
  
  CONCLUSIONS
  For frail older people residing in the community, a 12-month multifactorial intervention provided better value for money than usual care, particularly for the very frail, in whom it has a high probability of being cost saving, as well as effective. Trial registration: ACTRN12608000250336.
authors.affiliation: Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Sydney, Australia.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fairhall
authors.affiliation: The George Institute for Global Health, The University of Sydney, Sydney, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sherrington
authors.affiliation: Rehabilitation and Aged Care Services, Hornsby Ku-ring-gai Hospital, Sydney, Australia.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Kurrle
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, Australia.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
authors.affiliation: Rehabilitation and Aged Care Services, Hornsby Ku-ring-gai Hospital, Sydney, Australia.
authors.forename: Keri
authors.initials: K
authors.lastname: Lockwood
authors.affiliation: Sydney School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
authors.affiliation: Sydney School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Hayes
authors.affiliation: Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Sydney, Australia.
authors.forename: Noeline
authors.initials: N
authors.lastname: Monaghan
authors.affiliation: Rehabilitation and Aged Care Services, Hornsby Ku-ring-gai Hospital, Sydney, Australia.
authors.forename: Colleen
authors.initials: C
authors.lastname: Langron
authors.affiliation: Faculty of Nursing and Midwifery, The University of Sydney, Sydney, Australia.
authors.forename: Christina
authors.initials: C
authors.lastname: Aggar
authors.affiliation: Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Sydney, Australia. Electronic address: ian.cameron@sydney.edu.au.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Cameron
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000191:economics* / Q000379:methods*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D058025:Interdisciplinary Studies; D008297:Male; D051346:Mobility Limitation; D010348:Patient Care Team; D010809:Physical Fitness / Q000502:physiology*; D011788:Quality of Life
keywords: Frailty; cost-effectiveness; randomized controlled trial