title: Cost-Effectiveness of a Chronic Care Model for Frail Older Adults in Primary Care: Economic Evaluation Alongside a Stepped-Wedge Cluster-Randomized Trial.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of the Geriatric Care Model (GCM), an integrated care model for frail older adults based on the Chronic Care Model, with that of usual care.
  
  
  METHODS
  Economic evaluation alongside a 24-month stepped-wedge cluster-randomized controlled trial.
  
  
  METHODS
  Primary care (35 practices) in two regions in the Netherlands.
  
  
  METHODS
  Community-dwelling older adults who were frail according to their primary care physicians and the Program on Research for Integrating Services for the Maintenance of Autonomy case-finding tool questionnaire (N = 1,147).
  
  
  METHODS
  The GCM consisted of the following components: a regularly scheduled in-home comprehensive geriatric assessment by a practice nurse followed by a customized care plan, management and training of practice nurses by a geriatric expert team, and coordination of care through community network meetings and multidisciplinary team consultations of individuals with complex care needs.
  
  
  METHODS
  Outcomes were measured every 6 months and included costs from a societal perspective, health-related quality of life (Medical Outcomes Study 12-item Short-Form Survey (SF-12) physical (PCS) and mental component summary (MCS) scales), functional limitations (Katz activities of daily living and instrumental activities of daily living), and quality-adjusted life years based on the EQ-5D.
  
  
  RESULTS
  Multilevel regression models adjusted for time and baseline confounders showed no significant differences in costs ($356, 95% confidence interval = -$488-1,134) and outcomes between intervention and usual care phases. Cost-effectiveness acceptability curves showed that, for the SF-12 PCS and MCS, the probability of the intervention being cost-effective was 0.76 if decision-makers are willing to pay $30,000 per point improvement on the SF-12 scales (range 0-100). For all other outcomes the probability of the intervention being cost-effective was low.
  
  
  CONCLUSIONS
  Because the GCM was not cost-effective compared to usual care after 24 months of follow-up, widespread implementation in its current form is not recommended.
authors.affiliation: Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.|Department of Health Sciences, Faculty of Earth & Life Sciences, Emgo+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands.
authors.forename: Karen M
authors.initials: KM
authors.lastname: van Leeuwen
authors.affiliation: Department of Health Sciences, Faculty of Earth & Life Sciences, Emgo+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Bosmans
authors.affiliation: Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Aaltje P D
authors.initials: AP
authors.lastname: Jansen
authors.affiliation: Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.|Gérôntopole, Toulouse University Hospital, Toulouse, France.
authors.forename: Emiel O
authors.initials: EO
authors.lastname: Hoogendijk
authors.affiliation: Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.|Department of Medical Humanities, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Maaike E
authors.initials: ME
authors.lastname: Muntinga
authors.affiliation: Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Hein P J
authors.initials: HP
authors.lastname: van Hout
authors.affiliation: Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Giel
authors.initials: G
authors.lastname: Nijpels
authors.affiliation: Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Henriette E
authors.initials: HE
authors.lastname: van der Horst
authors.affiliation: Department of Health Sciences, Faculty of Earth & Life Sciences, Emgo+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands.
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
keywords: economic evaluation; frail older adults; integrated care; primary care; stepped-wedge randomized controlled trial