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Departments of 1 Geriatric Medicine, 2 Epidemiology, Biostatistics, and Health Technology Assessment, 3 Centre for Quality of Care Research, and5
Department of General Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
4 Neurotec, Division of Geriatric Epidemiology, Karolinska Institutet, Stockholm, Sweden.
Address correspondence to René J. F. Melis, MD, Radboud University Nijmegen Medical Centre, Department of Geriatric Medicine 925, PO Box 9101, NL, 6500 HB, Nijmegen, The Netherlands. E-mail: r.melis{at}ger.umcn.nl
Background. There is growing interest in geriatric care for community-dwelling older people. There are, however, relatively few reports on the economics of this type of care. This article reports about the cost-effectiveness of the Dutch Geriatric Intervention Program (DGIP) compared to usual care in frail older people at 6-month follow-up from a health care system's point of view.
Methods. We conducted this economic evaluation in an observer-blind randomized controlled trial (Dutch EASYcare Study: ClinicalTrials.gov Identifier NCT00105378). Difference in treatment effect was calculated as the difference in proportions of successfully treated patients (prevented functional decline accompanied by improved well-being). Incremental treatment costs were calculated as the difference in mean total care costs. The incremental cost-effectiveness ratio (ICER) was expressed as total cost per successful treatment. Bootstrap methods were used to determine confidence intervals (CI) for these measures.
Results. The average cost of the intervention under study (DGIP) was 998 euros (95% CI, 888–1108). The increment in total cost resulting from DGIP was a little over 761 euros (–3336 to 4687). Hospitalization and institutionalization costs were less; home care, adult day care, and meals-on-wheels costs were higher. There was a significant difference in proportions of successful treatments of 22.3% (4.3–41.4). The number needed to treat was approximately 4.7 (2.3–18.0). The ICER is 3418 euros per successful treatment (–21,458 to 45,362). The new treatment is cost-effective at a willingness-to-pay of 34,000 euros.
Conclusion. The results of this economic evaluation suggest that DGIP is an effective addition to primary care for frail older people at a reasonable cost.
This article has been cited by other articles:
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  R. J. F. Melis, M. I. J. van Eijken, S. Teerenstra, T. van Achterberg, S. G. Parker, G. F. Borm, E. H. van de Lisdonk, M. Wensing, and M. G. M. O. Rikkert Multidimensional Geriatric Assessment: Back to the Future A Randomized Study of a Multidisciplinary Program to Intervene on Geriatric Syndromes in Vulnerable Older People Who Live at Home (Dutch EASYcare Study) J. Gerontol. A Biol. Sci. Med. Sci., March 1, 2008; 63(3): 283 - 290. [Abstract] [Full Text] [PDF]
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A. Huss, A. E. Stuck, L. Z. Rubenstein, M. Egger, and K. M. Clough-Gorr Multidimensional Geriatric Assessment: Back to the Future Multidimensional Preventive Home Visit Programs for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials J. Gerontol. A Biol. Sci. Med. Sci., March 1, 2008; 63(3): 298 - 307. [Abstract] [Full Text] [PDF]
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