Department of Ageing and Health, Perioperative Medicine for Older People Undergoing Surgery (POPS), Guy's and St Thomas' NHS Foundation Trust, London, UK.
School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Age Ageing. 2021 Sep 11;50(5):1770-1777. doi: 10.1093/ageing/afab094.
increasing numbers of older people are undergoing vascular surgery. Preoperative comprehensive geriatric assessment and optimisation (CGA) reduces postoperative complications and length of hospital stay. Establishing CGA-based perioperative services requires health economic evaluation prior to implementation. Through a modelling-based economic evaluation, using data from a single site clinical trial, this study evaluates whether CGA is a cost-effective alternative to standard preoperative assessment for older patients undergoing elective arterial surgery.
an economic evaluation, using decision-analytic modelling, comparing preoperative CGA and optimisation with standard preoperative care, was undertaken in older patients undergoing elective arterial surgery. The incremental net health benefit of CGA, expressed in terms of quality-adjusted life-years (QALYs), was used to evaluate cost-effectiveness.
CGA is a cost-effective substitute for standard preoperative care in elective arterial surgery across a range of cost-effectiveness threshold values. An incremental net benefit of 0.58 QALYs at a cost-effectiveness threshold of £30k, 0.60 QALYs at a threshold of £20k and 0.63 QALYs at a threshold of £13k was observed. Mean total pre- and postoperative health care utilisation costs were estimated to be £1,165 lower for CGA patients largely accounted for by reduced postoperative bed day utilisation.
this study demonstrates a likely health economic benefit in addition to the previously described clinical benefit of employing CGA methodology in the preoperative setting in older patients undergoing arterial surgery. Further evaluation should examine whether CGA-based perioperative services can be effectively implemented and achieve the same clinical and health economic outcomes at scale.
越来越多的老年人接受血管手术。术前综合老年评估和优化（CGA）可减少术后并发症和住院时间。建立基于 CGA 的围手术期服务需要在实施前进行健康经济评估。通过基于模型的经济评估，使用来自单个临床试验的数据，本研究评估了 CGA 是否是对接受择期动脉手术的老年患者进行标准术前评估的一种更具成本效益的替代方案。
在接受择期动脉手术的老年患者中，进行了一项经济评估，使用决策分析模型比较术前 CGA 和优化与标准术前护理。CGA 的增量净健康效益以质量调整生命年（QALYs）表示，用于评估成本效益。
CGA 在一系列成本效益阈值下是择期动脉手术中标准术前护理的一种具有成本效益的替代方案。在成本效益阈值为 30 千英镑时，增量净效益为 0.58 QALYs，在阈值为 20 千英镑时为 0.60 QALYs，在阈值为 13 千英镑时为 0.63 QALYs。观察到 CGA 患者的总术前和术后医疗保健利用成本估计平均降低了 1165 英镑，这主要是由于术后床位日利用减少所致。
本研究除了先前描述的 CGA 方法在接受动脉手术的老年患者术前环境中的临床益处外，还证明了其具有可能的健康经济效益。进一步的评估应检查基于 CGA 的围手术期服务是否可以有效实施，并在大规模上实现相同的临床和健康经济效益。
