Journal Article

Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: Results of a cluster randomized trial

Suijker, Jacqueline J., Buurman, Bianca M., Bosmans, Judith E., de Rooij, Sophia E., van Rijn, Marjon, MacNeil-Vroomen, Janet L., Moll van Charante, Eric P.

2017

Overview

To evaluate the cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people in comparison with usual care. We conducted cost-effectiveness and cost-utility analyses alongside a cluster randomized trial with one-year follow-up. Participants were aged ≥ 70 years and at increased risk of functional decline. Participants in the intervention group (n = 1209) received a comprehensive geriatric assessment and individually tailored multifactorial interventions coordinated by a community-care registered nurse with multiple follow-up visits. The control group (n = 1074) received usual care. Costs were assessed from a healthcare perspective. Outcome measures included disability (modified Katz-Activities of Daily Living (ADL) index score), and quality-adjusted life-years (QALYs). Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated using bootstrapped bivariate regression models while adjusting for confounders. There were no statistically significant differences in Katz-ADL index score and QALYs between the two groups. Total mean costs were significantly higher in the intervention group (EUR 6518 (SE 472) compared with usual care (EUR 5214 (SE 338); adjusted mean difference €1457 (95% CI: 572; 2537). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.14 at a willingness to pay (WTP) of EUR 50,000 per one point improvement on the Katz-ADL index score and 0.04 at a WTP of EUR 50,000 per QALY gained. The current intervention was not cost-effective compared to usual care to prevent or postpone new disabilities over a one-year period. Based on these findings, implementation of the evaluated multifactorial nurse-led care model is not to be recommended.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Activities of Daily Living / Adults / Aged / Aged, 80 and over / Aging / Antibodies / Carcinoembryonic antigen / Chronic conditions / Clinical trials / Cluster Analysis / Clusters / Community Health Nursing - economics / Community participation / Cost analysis / Cost assessments / Cost engineering / Cost-Benefit Analysis / Dementia disorders / Disabilities / Disability / Disabled Persons / Economic aspects / Economic models / Economics / Economics, Nursing / Elderly / Epidemiology / Ethical standards / Evaluation / Falling / Female / Fibrillation / Frailty / Geriatric Assessment / Geriatrics / Gerontology / Health aspects / Health care / Health Care Costs / Health risks / Health Services for the Aged - economics / Human behavior / Humans / Internal medicine / Intervention / Life span / Male / Medical personnel / Medicine / Medicine and Health Sciences / Models, Economic / Models, Nursing / Netherlands / Nurses / Nursing / Nursing Care / Nursing homes / Older people / People and Places / Performance tests / Personal computers / Pharmacology / Physical training / Practice / Prevention / Primary care / Protocol (computers) / Quality of life / Quality-Adjusted Life Years / Regression models / Risk assessment / Risk factors / Social Sciences / Society / Soil fertility / Studies / Training / Vanes