title: Reducing disability in community-dwelling frail older people: cost-effectiveness study alongside a cluster randomised controlled trial.
abstract: BACKGROUND
  although proactive primary care, including early detection and treatment of community-dwelling frail older people, is a part of the national healthcare policy in several countries, little is known about its cost-effectiveness.
  
  
  OBJECTIVE
  to evaluate the cost-effectiveness of a proactive primary care approach in community-dwelling frail older people.
  
  
  METHODS
  embedded in a cluster randomised trial among 12 Dutch general practitioner practices, an economic evaluation was performed from a societal perspective with a time horizon of 24 months.
  
  
  METHODS
  frail older people in the intervention group received an in-home assessment and interdisciplinary care based on a tailor-made treatment plan and regular evaluation and follow-up. Practices in the control group delivered usual care. The primary outcome for the cost-effectiveness and cost-utility analysis was disability and health-related quality of life, respectively.
  
  
  RESULTS
  multilevel analyses among 346 frail older people showed no significant differences between the groups regarding disability and health-related quality of life at 24 months. People in the intervention group used, as expected, more primary care services, but there was no decline in more expensive hospital and long-term care. Total costs over 24 months tended to be higher in the intervention group than in the control group (€26,503 versus €20,550, P = 0.08).
  
  
  CONCLUSIONS
  the intervention under study led to an increase in healthcare utilisation and related costs without providing any beneficial effects. This study adds to the scarce amount of evidence of the cost-effectiveness of proactive primary care in community-dwelling frail older people.
  
  
  BACKGROUND
  Current Controlled Trials, ISRCTN 31954692.
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, Limburg the Netherlands.
authors.forename: Silke F
authors.initials: SF
authors.lastname: Metzelthin
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, Limburg the Netherlands Centre of Research on Autonomy and Participation, Zuyd University of Applied Sciences, Heerlen, Limburg, the Netherlands Centre of Research on Technology in Care, Zuyd University of Applied Sciences, Heerlen, Limburg, the Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: van Rossum
authors.affiliation: Department of Human Movement Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, Limburg, the Netherlands Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, North Holland, the Netherlands.
authors.forename: Marike R C
authors.initials: MR
authors.lastname: Hendriks
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, Limburg the Netherlands Centre of Research on Autonomy and Participation, Zuyd University of Applied Sciences, Heerlen, Limburg, the Netherlands Centre of Research on Technology in Care, Zuyd University of Applied Sciences, Heerlen, Limburg, the Netherlands.
authors.forename: Luc P
authors.initials: LP
authors.lastname: De Witte
authors.affiliation: Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Limburg, the Netherlands.
authors.forename: Sjoerd O
authors.initials: SO
authors.lastname: Hobma
authors.affiliation: Orbis Medical Centre, Sittard-Geleen, Limburg, the Netherlands.
authors.forename: Walther
authors.initials: W
authors.lastname: Sipers
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, Limburg the Netherlands.
authors.forename: Gertrudis I J M
authors.initials: GI
authors.lastname: Kempen
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly; D005853:Geriatrics / Q000191:economics / Q000379:methods*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D008297:Male; D010348:Patient Care Team; D057285:Precision Medicine / Q000379:methods; D011788:Quality of Life
keywords: cost-effectiveness; frail older adults; general practice; geriatric assessments; home-visiting programme; older people