Economic Evaluation of a Multifactorial, Interdisciplinary Intervention Versus Usual Care to Reduce Frailty in Frail Older People
Economic Evaluation of a Multifactorial, Interdisciplinary Intervention Versus Usual Care to Reduce Frailty in Frail Older People
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DOI：
10.1016/j.jamda.2014.07.006
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发表时间：
2015-01-01
影响因子：
7.6
通讯作者：
Cameron, Ian D.
中科院分区：
文献类型：
--
作者：
Fairhall, Nicola;Sherrington, Catherine;Cameron, Ian D.
目的：比较多因素跨学科干预与常规护理老年人谁是体弱的成本和成本效益。设计：成本效益研究嵌入在一个随机对照试验。设置：以社区为基础的干预在悉尼，澳大利亚。参与者：共241名社区居住的人70岁或以上谁符合心血管健康研究标准的虚弱。干预：一个12个月的多因素，跨学科的干预，针对确定的脆弱性特征与平时care.Measurements：健康和社会服务的使用，脆弱性和健康相关的生活质量（EQ-5D）进行了测量，在12个月的干预期间。干预组和对照组12个月的人均成本（增量成本）之间的差异和增量成本与有效性之间的比率进行了计算。结果：共有216名参与者（90%）完成了研究。在12个月时，干预组的虚弱患病率比对照组低14.7%（95% CI 2.4%-27.0%; P = 0.02）。EQ-5D效用评分无显著组间差异。额外1人摆脱虚弱的费用为15 955澳元（按2011年价格计算）。在“非常虚弱”亚组（参与者符合>3项心血管健康研究虚弱标准）中，干预比对照组更有效，成本更低。成本效益可接受性曲线显示，如果决策者愿意为从虚弱过渡的每一个额外的人支付5万澳元，干预将具有80%的成本效益。在非常虚弱的亚群，这减少到25，000美元。结论：对于居住在社区的体弱老年人，12个月的多因素干预提供了更好的物有所值比通常的护理，特别是对于非常虚弱的人，它有很高的可能性是节省成本，以及有效的。(C)2015年AMDA -急性后和长期护理医学协会。
Objective: To compare the costs and cost-effectiveness of a multifactorial interdisciplinary intervention versus usual care for older people who are frail.Design: Cost-effectiveness study embedded within a randomized controlled trial.Setting: Community-based intervention in Sydney, Australia.Participants: A total of 241 community-dwelling people 70 years or older who met the Cardiovascular Health Study criteria for frailty.Intervention: A 12-month multifactorial, interdisciplinary intervention targeting identified frailty characteristics versus usual care.Measurements: Health and social service use, frailty, and health-related quality of life (EQ-5D) were measured over the 12-month intervention period. The difference between the mean cost per person for 12 months in the intervention and control groups (incremental cost) and the ratio between incremental cost and effectiveness were calculated.Results: A total of 216 participants (90%) completed the study. The prevalence of frailty was 14.7% lower in the intervention group compared with the control group at 12 months (95% CI 2.4%-27.0%; P = .02). There was no significant between-group difference in EQ-5D utility scores. The cost for 1 extra person to transition out of frailty was $A15,955 (at 2011 prices). In the "very frail" subgroup (participants met >3 Cardiovascular Health Study frailty criteria), the intervention was both more effective and less costly than the control. A cost-effectiveness acceptability curve shows that the intervention would be cost-effective with 80% certainty if decision makers were willing to pay $A50,000 per extra person transitioning from frailty. In the very frail subpopulation, this reduced to $25,000.Conclusion: For frail older people residing in the community, a 12-month multifactorial intervention provided better value for money than usual care, particularly for the very frail, in whom it has a high probability of being cost saving, as well as effective. (C) 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine.