Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhättan-Uddevalla-Vänersborg, Sweden; Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J Am Med Dir Assoc. 2018 Oct;19(10):871-878.e2. doi: 10.1016/j.jamda.2018.04.003. Epub 2018 May 18.
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.
Clinical, prospective, controlled, 1-center intervention trial with 2 parallel groups.
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.
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.
The primary outcome was the adjusted incremental cost-effectiveness ratio associated with the intervention compared to the control at the 3-month follow-up.
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).
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.
本研究旨在从社会角度评估健康相关生活质量和成本，估算在急性医疗保健中对虚弱老年患者进行综合老年评估（CGA）与常规医疗相比的 3 个月内试验内成本效益。
临床、前瞻性、对照、单中心干预试验，设 2 个平行组。
在急性老年护理病房中进行结构化、系统的跨学科基于 CGA 的护理。如果患者符合纳入标准，并且 CGA 病房有空床，患者将被纳入干预组。如果 CGA 病房没有床位，患者将被纳入对照组并入住常规急性医疗护理病房。
瑞典西部一家大型县医院。该试验纳入了 408 名需要住院治疗的虚弱老年患者（年龄≥75 岁）。患者被分配到干预组（n=206）或对照组（n=202）。患者的平均年龄为 85.7 岁，56%为女性。
主要结局是与对照组相比，干预组在 3 个月随访时的调整增量成本效益比。
我们进行了成本效益分析，通过回归分析进行调整，包括医院、初级和市政保健费用和效果。3 个月时，两组间平均调整后的健康调整生命年差值为 0.0252（95%置信区间：0.0082-0.0422）。组间的增量成本（即差异）为-3226 美元（95%置信区间：-6167 至-285）。
结果表明，与常规护理相比，急性病虚弱老年患者在 CGA 病房接受护理在 3 个月后可能具有成本效益。
