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Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: Results of a cluster randomized trial

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  • Jacqueline J Suijker
  • Janet L MacNeil-Vroomen
  • Marjon van Rijn
  • Bianca M Buurman
  • Sophia E de Rooij
  • Eric P Moll van Charante
  • Judith E Bosmans

Abstract

Objective: To evaluate the cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people in comparison with usual care. Methods: We conducted cost-effectiveness and cost-utility analyses alongside a cluster randomized trial with one-year follow-up. Participants were aged ≥ 70 years and at increased risk of functional decline. Participants in the intervention group (n = 1209) received a comprehensive geriatric assessment and individually tailored multifactorial interventions coordinated by a community-care registered nurse with multiple follow-up visits. The control group (n = 1074) received usual care. Costs were assessed from a healthcare perspective. Outcome measures included disability (modified Katz-Activities of Daily Living (ADL) index score), and quality-adjusted life-years (QALYs). Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated using bootstrapped bivariate regression models while adjusting for confounders. Results: There were no statistically significant differences in Katz-ADL index score and QALYs between the two groups. Total mean costs were significantly higher in the intervention group (EUR 6518 (SE 472) compared with usual care (EUR 5214 (SE 338); adjusted mean difference €1457 (95% CI: 572; 2537). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.14 at a willingness to pay (WTP) of EUR 50,000 per one point improvement on the Katz-ADL index score and 0.04 at a WTP of EUR 50,000 per QALY gained. Conclusion: The current intervention was not cost-effective compared to usual care to prevent or postpone new disabilities over a one-year period. Based on these findings, implementation of the evaluated multifactorial nurse-led care model is not to be recommended.

Suggested Citation

  • Jacqueline J Suijker & Janet L MacNeil-Vroomen & Marjon van Rijn & Bianca M Buurman & Sophia E de Rooij & Eric P Moll van Charante & Judith E Bosmans, 2017. "Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: Results of a cluster randomized trial," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-16, April.
    • Handle: RePEc:plo:pone00:0175272
    DOI: 10.1371/journal.pone.0175272
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    References listed on IDEAS

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    1. Rita Faria & Manuel Gomes & David Epstein & Ian White, 2014. "A Guide to Handling Missing Data in Cost-Effectiveness Analysis Conducted Within Randomised Controlled Trials," PharmacoEconomics, Springer, vol. 32(12), pages 1157-1170, December.
    2. Réjean Hébert & Michel Raîche & Marie-France Dubois & N'Deye R. Gueye & Nicole Dubuc & Michel Tousignant, 2009. "Impact of PRISMA, a Coordination-Type Integrated Service Delivery System for Frail Older People in Quebec (Canada): A Quasi-experimental Study," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 65(1), pages 107-118.
    3. Evan Mayo-Wilson & Sean Grant & Jennifer Burton & Amanda Parsons & Kristen Underhill & Paul Montgomery, 2014. "Preventive Home Visits for Mortality, Morbidity, and Institutionalization in Older Adults: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-1, March.
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    1. Hossein Haji Ali Afzali & Jonathan Karnon & Olga Theou & Justin Beilby & Matteo Cesari & Renuka Visvanathan, 2019. "Structuring a conceptual model for cost-effectiveness analysis of frailty interventions," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-13, September.
    2. Yining Xu & Xin Li & Zhihong Sun & Yang Song & Julien S. Baker & Yaodong Gu, 2021. "Adjusted Indirect and Mixed Comparisons of Interventions for the Patient-Reported Outcomes Measures (PROMs) of Disabled Adults: A Systematic Review and Network Meta-Analysis," IJERPH, MDPI, vol. 18(5), pages 1-29, March.
    3. Beata Wieczorek-Wójcik & Aleksandra Gaworska-Krzemińska & Piotr Szynkiewicz & Michał Wójcik & Monika Orzechowska & Dorota Kilańska, 2022. "Cost-Effectiveness Analysis of Improving Nurses’ Education Level in the Context of In-Hospital Mortality," IJERPH, MDPI, vol. 19(2), pages 1-15, January.

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