title: Cost-effectiveness of the 'Walcheren Integrated Care Model' intervention for community-dwelling frail elderly.
abstract: BACKGROUND
  An important aim of integrated care for frail elderly is to generate more cost-effective health care. However, empirical research on the cost-effectiveness of integrated care for community-dwelling frail elderly is limited.
  
  
  OBJECTIVE
  This study reports on the cost-effectiveness of the Walcheren Integrated Care Model (WICM) after 12 months from a societal perspective.
  
  
  METHODS
  The design of this study was quasi-experimental. In total, 184 frail elderly patients from 3 GP practices that implemented the WICM were compared with 193 frail elderly patients of 5 GP practices that provided care as usual. Effects were determined by health-related quality of life (EQ-5D questionnaire). Costs were assessed based on questionnaires, GP files, time registrations and reports from multidisciplinary meetings. Average costs and effects were compared using t-tests. The incremental cost-effectiveness ratio (ICER) was calculated, and bootstrap methods were used to determine its reliability.
  
  
  RESULTS
  Neither the WICM nor care as usual resulted in a change in health-related quality of life. The average total costs of the WICM were higher than care as usual (17089 euros versus 15189 euros). The incremental effects were 0.00, whereas the incremental costs were 1970 euros, indicating an ICER of 412450 euros.
  
  
  CONCLUSIONS
  The WICM is not cost-effective, and the costs per quality-adjusted life year are high. The costs of the integrated care intervention do not outweigh the limited effects on health-related quality of life after 12 months. More analyses of the cost-effectiveness of integrated care for community-dwelling frail elderly are recommended as well as consideration of the specific costs and effects.
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. looman@bmg.eur.nl.
authors.forename: Wilhelmina M
authors.initials: WM
authors.lastname: Looman
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Robbert
authors.initials: R
authors.lastname: Huijsman
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Clazien A M
authors.initials: CA
authors.lastname: Bouwmans-Frijters
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Elly A
authors.initials: EA
authors.lastname: Stolk
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Isabelle N
authors.initials: IN
authors.lastname: Fabbricotti
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000379:methods; D005260:Female; D016330:Frail Elderly; D017048:Health Care Costs; D006801:Humans; D057187:Independent Living; D008297:Male; D009426:Netherlands; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires
keywords: Cost-effectiveness; economic evaluation; frail elderly; general practice; integrated health care systems; prevention.
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