Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical geriatrics, Karolinska Institute (KI), Stockholm, Sweden.
BMC Geriatr. 2018 Jan 31;18(1):32. doi: 10.1186/s12877-017-0703-1.
Older people with multi-morbidity are increasingly challenging for today's healthcare, and novel, cost-effective healthcare solutions are needed. The aim of this study was to assess the cost-effectiveness of comprehensive geriatric assessment (CGA) at an ambulatory geriatric unit for people ≥75 years with multi-morbidity.
The primary outcome was the incremental cost-effectiveness ratio (ICER) comparing costs and quality-adjusted life years (QALYs) of a CGA strategy with usual care in a Swedish setting. Outcomes were estimated over a lifelong time horizon using decision-analytic modelling based on data from the randomized AGe-FIT trial. The analysis employed a public health care sector perspective. Costs and QALYs were discounted by 3% per annum and are reported in 2016 euros.
Compared with usual care CGA was associated with a per patient mean incremental cost of approximately 25,000 EUR and a gain of 0.54 QALYs resulting in an ICER of 46,000 EUR. The incremental costs were primarily caused by intervention costs and costs associated with increased survival, whereas the gain in QALYs was primarily a consequence of the fact that patients in the CGA group lived longer.
CGA in an ambulatory setting for older people with multi-morbidity results in a cost per QALY of 46,000 EUR compared with usual care, a figure generally considered reasonable in a Swedish healthcare context. A rather simple reorganisation of care for older people with multi-morbidity may therefore cost effectively contribute to meet the needs of this complex patient population.
The trial was retrospectively registered in clinicaltrial.gov, NCT01446757 . September, 2011.
患有多种疾病的老年人对当今的医疗保健提出了越来越大的挑战，因此需要新颖、具有成本效益的医疗保健解决方案。本研究旨在评估在门诊老年病房对患有多种疾病的≥75 岁老年人进行综合老年评估（CGA）的成本效果。
主要结局是在瑞典背景下，比较 CGA 策略与常规护理的成本效果比（ICER），使用来自随机 AGe-FIT 试验的数据，基于决策分析模型，对终生时间范围内的结果进行估计。该分析采用公共医疗保健部门的观点。成本和 QALYs 每年贴现 3%，并以 2016 年欧元报告。
与常规护理相比，CGA 每位患者的平均增量成本约为 25,000 欧元，每增加 0.54 个 QALY 导致 ICER 为 46,000 欧元。增量成本主要是由于干预成本和与生存增加相关的成本所致，而 QALY 的增加主要是由于 CGA 组的患者寿命更长。
与常规护理相比，在门诊环境中对患有多种疾病的老年人进行 CGA 会导致每 QALY 的成本为 46,000 欧元，这在瑞典医疗保健环境中通常被认为是合理的。因此，对患有多种疾病的老年人进行相对简单的护理重新组织可能会以具有成本效益的方式满足这一复杂患者群体的需求。
该试验在 clinicaltrial.gov 上进行了回顾性注册，NCT01446757。2011 年 9 月。
