Nord Magnus, Lyth Johan, Marcusson Jan, Alwin Jenny
Primary Health Care Center Valla, Valla, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
J Am Med Dir Assoc. 2022 Dec;23(12):2003-2009. doi: 10.1016/j.jamda.2022.04.007. Epub 2022 May 13.
To estimate the cost-effectiveness of a pragmatic trial of comprehensive geriatric assessment adapted to primary care, compared with care as usual.
Within-trial cost-effectiveness study of a prospective controlled multicenter trial.
Nineteen primary care practices in Sweden. The original trial included 1304 individuals aged ≥75 years at high risk of hospitalization selected using a prediction model. From the original trial, 369 individuals participated in the cost-effectiveness analysis, 185 in the intervention group and 184 in the control group. Mean age was 83.9 years and 57% of the participants were men.
We obtained health care costs from administrative registries. Community costs and health-related quality of life data were obtained from a questionnaire sent to participants. Health-related quality of life was measured using EQ-5D-3L and quality-adjusted life years were calculated. We analyzed all outcomes according to intention to treat, and adjusted them to age, gender, and risk score (risk of hospitalization in the next 12 months). The primary outcome was the incremental cost-effectiveness ratio associated with the intervention at follow-up after 24 months.
The difference in total cost (incremental cost) between intervention and control groups was USD -11,275 (95% CI -407 to -22,142). The incremental effect in quality-adjusted life years was -0.05 (95% CI -0.17 to 0.08). In the cost-effectiveness plane that illustrates the uncertainty of the analysis, 77.9 of the observations were within the south-east quadrant, implying lower cost and greater effect in the intervention group.
The results suggests that a primary care comprehensive geriatric assessment intervention delivered to older adults at high risk of hospitalization is cost-effective at follow-up after 24 months. The use of a prediction model to select participants and an intervention with a low cost is promising but requires further study.
评估一项适用于初级保健的综合老年评估实用试验相对于常规护理的成本效益。
一项前瞻性对照多中心试验的试验内成本效益研究。
瑞典的19家初级保健机构。原始试验纳入了1304名年龄≥75岁、使用预测模型选定的高住院风险个体。在原始试验中，369名个体参与了成本效益分析，干预组185名，对照组184名。平均年龄为83.9岁，57%的参与者为男性。
我们从行政登记处获取医疗保健成本。社区成本和与健康相关的生活质量数据通过向参与者发送的问卷获得。使用EQ-5D-3L测量与健康相关的生活质量，并计算质量调整生命年。我们根据意向性分析所有结局，并对其进行年龄、性别和风险评分（未来12个月内的住院风险）调整。主要结局是24个月随访时与干预相关的增量成本效益比。
干预组与对照组之间的总成本差异（增量成本）为-11,275美元（95%CI -407至-22,142）。质量调整生命年的增量效应为-0.05（95%CI -0.17至0.08）。在说明分析不确定性的成本效益平面中，77.9%的观察值位于东南象限，这意味着干预组成本更低且效果更佳。
结果表明，对高住院风险的老年人实施初级保健综合老年评估干预在24个月随访时具有成本效益。使用预测模型选择参与者以及低成本干预是有前景的，但需要进一步研究。
