title: Cost-utility analysis of a preventive home visit program for older adults in Germany.
abstract: BACKGROUND
  Most older adults want to live independently in a familiar environment instead of moving to a nursing home. Preventive home visits based on multidimensional geriatric assessment can be one strategy to support this preference and might additionally reduce health care costs, due to the avoidance of costly nursing home admissions. The purpose of this study was to analyse the cost-effectiveness of preventive home visits from a societal perspective in Germany.
  
  
  METHODS
  This study is part of a multi-centre, non-blinded, randomised controlled trial aiming at the reduction of nursing home admissions. Participants were older than 80 years and living at home. Up to three home visits were conducted to identify self-care deficits and risk factors, to present recommendations and to implement solutions. The control group received usual care. A cost-utility analysis using quality-adjusted life years (QALY) based on the EQ-5D was performed. Resource utilization was assessed by means of the interview version of a patient questionnaire. A cost-effectiveness acceptability curve controlled for prognostic variables was constructed and a sensitivity analysis to control for the influence of the mode of QALY calculation was performed.
  
  
  RESULTS
  278 individuals (intervention group: 133; control group: 145) were included in the analysis. During 18 months follow-up mean adjusted total cost (mean: +4,401 EUR; bootstrapped standard error: 3,019.61 EUR) and number of QALY (mean: 0.0061 QALY; bootstrapped standard error: 0.0388 QALY) were higher in the intervention group, but differences were not significant. For preventive home visits the probability of an incremental cost-effectiveness ratio <50,000 EUR per QALY was only 15%. The results were robust with respect to the mode of QALY calculation.
  
  
  CONCLUSIONS
  The evaluated preventive home visits programme is unlikely to be cost-effective.
  
  
  BACKGROUND
  Clinical Trials.gov Identifier: NCT00644826.
authors.affiliation: Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany. c.brettschneider@uke.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Brettschneider
authors.affiliation: University of Leipzig, Institute of Social Medicine, Occupational Health and Public Health, Leipzig, Germany. Tobias.Luck@medizin.uni-leipzig.de.|University of Leipzig, LIFE - Leipzig Research Center for Civilization Diseases, Leipzig, Germany. Tobias.Luck@medizin.uni-leipzig.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Luck
authors.affiliation: Martin-Luther-University Halle-Wittenberg, Institute for Health and Nursing Science, Halle, Germany. steffen.fleischer@medizin.uni-halle.de.
authors.forename: Steffen
authors.initials: S
authors.lastname: Fleischer
authors.affiliation: Martin-Luther-University Halle-Wittenberg, Institute for Health and Nursing Science, Halle, Germany. gudrun.roling@uni-wh.de.|Private University of Witten/ Herdecke, Institute for Integrative Medicine (IfIM), Integrated Curriculum for Anthroposophic Medicine (ICURAM), Witten, Germany. gudrun.roling@uni-wh.de.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Roling
authors.affiliation: Martin-Luther-University Halle-Wittenberg, Institute for Health and Nursing Science, Halle, Germany. katrin.beutner@medizin.uni-halle.de.
authors.forename: Katrin
authors.initials: K
authors.lastname: Beutner
authors.affiliation: University of Leipzig, Institute of Social Medicine, Occupational Health and Public Health, Leipzig, Germany. Melanie.Luppa@medizin.uni-leipzig.de.
authors.forename: Melanie
authors.initials: M
authors.lastname: Luppa
authors.affiliation: Martin-Luther-University Halle-Wittenberg, Institute for Health and Nursing Science, Halle, Germany. johann.behrens@medizin.uni-halle.de.|German Institute for Economic Research DIW, Berlin, Germany. johann.behrens@medizin.uni-halle.de.|ISIS-Institute for Supervision-, Institutions- and Social Research, Frankfurt a. M, Germany. johann.behrens@medizin.uni-halle.de.
authors.forename: Johann
authors.initials: J
authors.lastname: Behrens
authors.affiliation: University of Leipzig, Institute of Social Medicine, Occupational Health and Public Health, Leipzig, Germany. Steffi.Riedel-Heller@medizin.uni-leipzig.de.
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
authors.affiliation: Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany. h.koenig@uke.de.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
mesh_terms: D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000191:economics*; D006701:Home Nursing / Q000191:economics*; D006792:House Calls / Q000191:economics*; D006801:Humans; D008297:Male; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000191:economics*; D011795:Surveys and Questionnaires