M J Long1, B S Marshall. 1. Department of Public Health Sciences, Wichita State University, USA. long@chp.twsu.edu
Abstract
OBJECTIVE: To examine the costs and benefits of a case-management program for an elderly, functionally impaired population in a managed care setting. STUDY DESIGN: A post hoc, cost-effectiveness study of case management. SUBJECTS AND METHODS: As part of a larger study, 317 elderly, functionally impaired clients were randomly assigned to a case-managed or regular-care group. During the 2-year study period, 34 clients in the case-managed and 43 clients in the regular-care group died. A post hoc analysis of the difference in average total cost per person, death rates, and average number of days of exposure per person were assessed to determine the cost per life saved and cost per additional day of life. RESULTS: Although the average costs for the case-managed group were greater than the costs for the regular-care group, clients in the case-managed group lived an average of 106 days longer. The cost per additional day of life was $40. The difference in death rates was so small that, by extrapolation, the cost per life saved was over $42 million. CONCLUSION: Although the case-management program was more costly when viewed from a purely fiscal perspective, it may very well be considered a success when its benefits are evaluated. The case-management program improved quality and was associated with prolonged life at a cost of $40 per day of additional life. Additional research involving other patient populations, study settings, and case-management models is warranted.
RCT Entities:
OBJECTIVE: To examine the costs and benefits of a case-management program for an elderly, functionally impaired population in a managed care setting. STUDY DESIGN: A post hoc, cost-effectiveness study of case management. SUBJECTS AND METHODS: As part of a larger study, 317 elderly, functionally impaired clients were randomly assigned to a case-managed or regular-care group. During the 2-year study period, 34 clients in the case-managed and 43 clients in the regular-care group died. A post hoc analysis of the difference in average total cost per person, death rates, and average number of days of exposure per person were assessed to determine the cost per life saved and cost per additional day of life. RESULTS: Although the average costs for the case-managed group were greater than the costs for the regular-care group, clients in the case-managed group lived an average of 106 days longer. The cost per additional day of life was $40. The difference in death rates was so small that, by extrapolation, the cost per life saved was over $42 million. CONCLUSION: Although the case-management program was more costly when viewed from a purely fiscal perspective, it may very well be considered a success when its benefits are evaluated. The case-management program improved quality and was associated with prolonged life at a cost of $40 per day of additional life. Additional research involving other patient populations, study settings, and case-management models is warranted.
Authors: Annicka G M van der Plas; Bregje D Onwuteaka-Philipsen; Marlies van de Watering; Wim J J Jansen; Kris C Vissers; Luc Deliens Journal: BMC Health Serv Res Date: 2012-06-18 Impact factor: 2.655
Authors: Ronald J Uittenbroek; Sijrike F van der Mei; Karin Slotman; Sijmen A Reijneveld; Klaske Wynia Journal: PLoS One Date: 2018-11-15 Impact factor: 3.240