Nicola Fairhall1, Catherine Sherrington2, Susan E Kurrle3, Stephen R Lord4, Keri Lockwood3, Kirsten Howard5, Alison Hayes5, Noeline Monaghan1, Colleen Langron3, Christina Aggar6, Ian D Cameron7. 1. Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Sydney, Australia. 2. The George Institute for Global Health, The University of Sydney, Sydney, Australia. 3. Rehabilitation and Aged Care Services, Hornsby Ku-ring-gai Hospital, Sydney, Australia. 4. Neuroscience Research Australia, University of New South Wales, Sydney, Australia. 5. Sydney School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, Australia. 6. Faculty of Nursing and Midwifery, The University of Sydney, Sydney, Australia. 7. Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Sydney, Australia. Electronic address: ian.cameron@sydney.edu.au.
Abstract
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. Trial registration: ACTRN12608000250336.
RCT Entities:
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. Trial registration: ACTRN12608000250336.
Authors: João Apóstolo; Richard Cooke; Elzbieta Bobrowicz-Campos; Silvina Santana; Maura Marcucci; Antonio Cano; Miriam Vollenbroek-Hutten; Federico Germini; Barbara D'Avanzo; Holly Gwyther; Carol Holland Journal: JBI Database System Rev Implement Rep Date: 2018-01
Authors: João Apóstolo; Richard Cooke; Elzbieta Bobrowicz-Campos; Silvina Santana; Maura Marcucci; Antonio Cano; Miriam Vollenbroek-Hutten; Federico Germini; Barbara D'Avanzo; Holly Gwyther; Carol Holland Journal: JBI Database System Rev Implement Rep Date: 2018-05
Authors: G Liotta; O Madaro; P Scarcella; M C Inzerilli; B Frattini; F Riccardi; N Accarino; S Mancinelli; E Terracciano; S Orlando; M C Marazzi Journal: Transl Med UniSa Date: 2020-10-01
Authors: Heather Block; Alexandra Annesley; Keri Lockwood; Linda Xu; Ian D Cameron; Kate Laver; Maria Crotty; Catherine Sherrington; Annette Kifley; Kirsten Howard; Dimity Pond; Tuan A Nguyen; Susan E Kurrle Journal: BMC Geriatr Date: 2022-06-27 Impact factor: 4.070
Authors: Joanne Ryan; Sara Espinoza; Michael E Ernst; A R M Saifuddin Ekram; Rory Wolfe; Anne M Murray; Raj C Shah; Suzanne G Orchard; Sharyn Fitzgerald; Lawrence J Beilin; Stephanie A Ward; Jeff D Williamson; Anne B Newman; John J McNeil; Robyn L Woods Journal: J Gerontol A Biol Sci Med Sci Date: 2022-01-07 Impact factor: 6.591