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Short-term Resource Utilization and Cost-Effectiveness of Comprehensive Geriatric Assessment in Acute Hospital Care for Severely Frail Elderly Patients
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhättan-Uddevalla-Vänersborg, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. (Jedilab)
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
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2018 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, no 10, p. 871-878.e2Article in journal (Refereed) Published
Abstract [en]

Objective

The objective of this study was to estimate the 3-month within-trial cost-effectiveness of comprehensive geriatric assessment (CGA) in acute medical care for frail elderly patients compared to usual medical care, by estimating health-related quality of life and costs from a societal perspective.

Design

Clinical, prospective, controlled, 1-center intervention trial with 2 parallel groups.

Intervention

Structured, systematic interdisciplinary CGA-based care in an acute elderly care unit. If the patient fulfilled the inclusion criteria, and there was a bed available at the CGA unit, the patient was included in the intervention group. If no bed was available at the CGA unit, the patient was included in the control group and admitted to a conventional acute medical care unit.

Setting and Participants

A large county hospital in western Sweden. The trial included 408 frail elderly patients, 75 years or older, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n = 206) or control group (n = 202). Mean age of the patients was 85.7 years, and 56% were female.

Measures

The primary outcome was the adjusted incremental cost-effectiveness ratio associated with the intervention compared to the control at the 3-month follow-up.

Results

We undertook cost-effectiveness analysis, adjusted by regression analyses, including hospital, primary, and municipal care costs and effects. The difference in the mean adjusted quality-adjusted life years gained between groups at 3 months was 0.0252 [95% confidence interval (CI): 0.0082-0.0422]. The incremental cost, that is, the difference between the groups, was −3226 US dollars (95% CI: −6167 to −285).

Conclusion

The results indicate that the care in a CGA unit for acutely ill frail elderly patients is likely to be cost-effective compared to conventional care after 3 months.

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 19, no 10, p. 871-878.e2
Keywords [en]
Comprehensive Geriatric Assessment (CGA), frailty, elderly patients, cost-effectiveness, emergency care
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:liu:diva-154797DOI: 10.1016/j.jamda.2018.04.003ISI: 000445790500011PubMedID: 29784592Scopus ID: 2-s2.0-85047081533OAI: oai:DiVA.org:liu-154797DiVA, id: diva2:1292297
Available from: 2019-02-27 Created: 2019-02-27 Last updated: 2019-03-06Bibliographically approved

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Ekerstad, NiklasAndersson, DavidHusberg, MagnusCarlsson, Per

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