Geriatric assessment prior to cancer treatment: A health economic evaluation

Gordon A G McKenzie; Miriam J Johnson; Michael J Lind; Charlotte Kelly; Steve Parrott

doi:10.1016/j.jgo.2023.101504

Geriatric assessment prior to cancer treatment: A health economic evaluation

J Geriatr Oncol. 2023 Jul;14(6):101504. doi: 10.1016/j.jgo.2023.101504. Epub 2023 Jun 13.

Authors

Gordon A G McKenzie¹, Miriam J Johnson², Michael J Lind³, Charlotte Kelly², Steve Parrott⁴

Affiliations

¹ Cancer Research Group, Hull York Medical School, University of Hull, Hull, UK. Electronic address: [email protected].
² Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
³ Cancer Research Group, Hull York Medical School, University of Hull, Hull, UK.
⁴ Department of Health Sciences, University of York, York, UK.

PMID: 37320931
DOI: 10.1016/j.jgo.2023.101504

Abstract

Introduction: To address uncertainty regarding the cost-effectiveness of implementing geriatric assessment (GA) in oncology practice, we undertook a synthetic, model-based economic evaluation.

Materials and methods: A decision-analytic model with embedded Markov chains was developed to simulate a cost-effectiveness analysis of implementing GA within standard oncological care compared to current practice. This was for patients aged 77 years (the mean age in included trials) receiving chemotherapy or surgery as first-line treatment. Assumptions were made about model parameters, based on available literature, to calculate the incremental net health benefit (INHB) of GA, using a data synthesis.

Results: GA has additional costs over standard care alone of between £390 and £576, depending upon implementation configuration. When major assumptions about the effectiveness of GA were modelled, INHB was marginally positive (0.09-0.12) at all cost-effectiveness thresholds (CETs). If no reduction in postoperative complications was assumed, the intervention was shown not to be cost-effective (INHB negative at all CETs). When used before chemotherapy, with minimal healthcare staffing inputs and technological assistance, GA is cost-effective (INHB positive between 0.06 and 0.07 at all CETs).

Discussion: Considering emerging evidence that GA improves outcomes in oncology, GA may not be a cost-effective intervention when used for all older adults with cancer. However, with judicious selection of implementation models, GA has the potential to be cost-effective. Due to significant heterogeneity and centre dependent success in implementation and effectiveness, GA is difficult to study in oncology settings. Stakeholders could take a pragmatic approach towards GA introduction with local evaluation favoured over generalisable research. Because GA tends towards utilitarianism and has no safety issues, it is a suitable intervention for more widespread implementation.

Keywords: Cancer; Cost-benefit analysis; Decision support techniques; Frailty; Geriatric assessment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cost-Benefit Analysis
Delivery of Health Care
Geriatric Assessment*
Humans
Neoplasms* / therapy