Economic evaluation of a multifactorial, interdisciplinary intervention versus usual care to reduce frailty in frail older people

Nicola Fairhall, Catherine Sherrington, Susan E Kurrle, Stephen R Lord, Keri Lockwood, Kirsten Howard, Alison Hayes, Noeline Monaghan, Colleen Langron, Christina Aggar, Ian D Cameron
Journal of the American Medical Directors Association 2015, 16 (1): 41-8

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.

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