Short-term Resource Utilization and Cost-Effectiveness of Comprehensive Geriatric Assessment in Acute Hospital Care for Severely Frail Elderly Patients.
OBJECTIVE
The objective of this study was to estimate the 3-month within-trial cost-effectiveness of comprehensive geriatric assessment (CGA) in acute medical care for frail elderly patients compared to usual medical care, by estimating health-related quality of life and costs from a societal perspective.


DESIGN
Clinical, prospective, controlled, 1-center intervention trial with 2 parallel groups.


INTERVENTION
Structured, systematic interdisciplinary CGA-based care in an acute elderly care unit. If the patient fulfilled the inclusion criteria, and there was a bed available at the CGA unit, the patient was included in the intervention group. If no bed was available at the CGA unit, the patient was included in the control group and admitted to a conventional acute medical care unit.


SETTING AND PARTICIPANTS
A large county hospital in western Sweden. The trial included 408 frail elderly patients, 75 years or older, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n = 206) or control group (n = 202). Mean age of the patients was 85.7 years, and 56% were female.


MEASURES
The primary outcome was the adjusted incremental cost-effectiveness ratio associated with the intervention compared to the control at the 3-month follow-up.


RESULTS
We undertook cost-effectiveness analysis, adjusted by regression analyses, including hospital, primary, and municipal care costs and effects. The difference in the mean adjusted quality-adjusted life years gained between groups at 3 months was 0.0252 [95% confidence interval (CI): 0.0082-0.0422]. The incremental cost, that is, the difference between the groups, was -3226 US dollars (95% CI: -6167 to -285).


CONCLUSION
The results indicate that the care in a CGA unit for acutely ill frail elderly patients is likely to be cost-effective compared to conventional care after 3 months.
['Ekerstad|Niklas|N|', 'Karlson|Björn W|BW|', 'Andersson|David|D|', 'Husberg|Magnus|M|', 'Carlsson|Per|P|', 'Heintz|Emelie|E|', 'Alwin|Jenny|J|']
D000369:Aged, 80 and over D003362:Cost-Benefit Analysis D005260:Female D016330:Frail Elderly D015577:Geriatric Assessment D006299:Health Services for the Aged D017721:Hospital Costs D006757:Hospital Units D006760:Hospitalization D006801:Humans D007902:Length of Stay D008297:Male D009819:Office Visits D011320:Primary Health Care D011446:Prospective Studies D011788:Quality of Life D019057:Quality-Adjusted Life Years D013548:Sweden
cost-effectiveness elderly patients Comprehensive Geriatric Assessment (CGA) emergency care frailty