Cost-Effectiveness of a Proactive Primary Care Program for Frail Older People: A Cluster-Randomized Controlled Trial

Nienke Bleijenberg; Irene Drubbel; Rabin Ej Neslo; Marieke J Schuurmans; Valerie H Ten Dam; Mattijs E Numans; G Ardine de Wit; Niek J de Wit

doi:10.1016/j.jamda.2017.06.023

Cost-Effectiveness of a Proactive Primary Care Program for Frail Older People: A Cluster-Randomized Controlled Trial

J Am Med Dir Assoc. 2017 Dec 1;18(12):1029-1036.e3. doi: 10.1016/j.jamda.2017.06.023. Epub 2017 Aug 8.

Authors

Nienke Bleijenberg¹, Irene Drubbel², Rabin Ej Neslo³, Marieke J Schuurmans⁴, Valerie H Ten Dam², Mattijs E Numans⁵, G Ardine de Wit⁶, Niek J de Wit²

Affiliations

¹ Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: [email protected].
² Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
³ Department Health Technology Assessment, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴ Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
⁵ Department of General Practice, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
⁶ Department Health Technology Assessment, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Department of General Practice, Leiden University Medical Center (LUMC), Leiden, The Netherlands.

PMID: 28801235
DOI: 10.1016/j.jamda.2017.06.023

Abstract

Background: A proactive integrated approach has shown to preserve daily functioning among older people in the community. The aim is to determine the cost-effectiveness of a proactive integrated primary care program.

Methods: Economic evaluation embedded in a single-blind, 3-armed, cluster-randomized controlled trial with 12 months' follow-up in 39 general practices in the Netherlands. General practices were randomized to one of 3 trial arms: (1) an electronic frailty screening instrument using routine medical record data followed by standard general practitioner (GP) care; (2) this screening instrument followed by a nurse-led care program; or (3) usual care. Health resource utilization data were collected using electronic medical records and questionnaires. Associated costs were calculated. A cost-effectiveness analysis from a societal perspective was undertaken. The incremental cost per quality-adjusted life-year was calculated comparing proactive screening arm with usual care, and screening plus nurse-led care arm with usual care, as well as the screening arm with screening plus nurse-led care arm.

Results: Out of 7638 potential participants, 3092 (40.5%) older adults participated. Whereas effect differences were minor, the total costs per patient were lower in both intervention groups compared with usual care. The probability of cost-effectiveness at €20,000 per QALY threshold was 87% and 91% for screening plus GP care versus usual care and for screening plus nurse-led care compared to usual care, respectively. For screening plus nurse-led care vs screening plus standard GP care, the probability was 55%.

Conclusion: A proactive screening intervention has a high probability of being cost-effective compared to usual care. The combined intervention showed less value for money.

Keywords: Cost-effectiveness analysis; cluster-randomized controlled trial; frailty; general practice; older people.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Activities of Daily Living*
Aged
Aged, 80 and over
Cluster Analysis
Cost-Benefit Analysis / economics*
Female
Frail Elderly / statistics & numerical data
Frailty / therapy*
Health Care Costs*
Humans
Male
Middle Aged
Netherlands
Patient Care Team / organization & administration
Primary Health Care / economics*
Primary Health Care / organization & administration
Quality-Adjusted Life Years
Risk Assessment
Single-Blind Method