Cargando…
Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons
BACKGROUND: The article reports on the cost-effectiveness of the proactive, integrated primary care program Finding and Follow-up of Frail older persons (FFF) compared with usual primary care for community-dwelling frail older persons in the Netherlands. METHODS: This study had a matched quasi-exper...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617694/ https://www.ncbi.nlm.nih.gov/pubmed/31333333 http://dx.doi.org/10.1186/s12962-019-0181-8 |
_version_ | 1783433749390688256 |
---|---|
author | Vestjens, Lotte Cramm, Jane M. Birnie, Erwin Nieboer, Anna P. |
author_facet | Vestjens, Lotte Cramm, Jane M. Birnie, Erwin Nieboer, Anna P. |
author_sort | Vestjens, Lotte |
collection | PubMed |
description | BACKGROUND: The article reports on the cost-effectiveness of the proactive, integrated primary care program Finding and Follow-up of Frail older persons (FFF) compared with usual primary care for community-dwelling frail older persons in the Netherlands. METHODS: This study had a matched quasi-experimental design (pretest and posttest). The economic evaluation was performed from a healthcare perspective with a time horizon of 12 months. The target population consisted of community-dwelling frail older persons aged ≥ 75 years in the FFF intervention group (11 general practitioner (GP) practices) and in the control group receiving usual care (4 GP practices). The effectiveness measures for the cost-effectiveness and cost-utility analyses were subjective well-being (Social Production Function Instrument for the Level of well-being short; SPF-ILs) and QALYs (EuroQol; EQ-5D-3L), respectively. Costs were assessed using resource use questionnaires. Differences in mean effectiveness between groups were assessed using univariate, multilevel and propensity score matched analyses, with and without imputation of missing values. Differences in costs were assessed using Mann–Whitney U-tests and independent samples t-tests. Bootstrapping was performed, and predicted incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs) were depicted on cost-effectiveness planes. RESULTS: The various analyses showed slightly different results with respect to differences in estimated costs and effects. Multilevel analyses showed a small but significant difference between the groups for well-being, in favor of the control group. No significant differences between groups in terms of QALYs were found. Imputed data showed that mean total costs were significantly higher in the intervention group at follow-up. CONCLUSION: Proactive, integrated care for community-dwelling frail older persons as provided in the FFF program is most likely not a cost-effective initiative, compared with usual primary care in the Netherlands, in terms of well-being and QALYs over a 12-month period. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12962-019-0181-8) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6617694 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-66176942019-07-22 Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons Vestjens, Lotte Cramm, Jane M. Birnie, Erwin Nieboer, Anna P. Cost Eff Resour Alloc Research BACKGROUND: The article reports on the cost-effectiveness of the proactive, integrated primary care program Finding and Follow-up of Frail older persons (FFF) compared with usual primary care for community-dwelling frail older persons in the Netherlands. METHODS: This study had a matched quasi-experimental design (pretest and posttest). The economic evaluation was performed from a healthcare perspective with a time horizon of 12 months. The target population consisted of community-dwelling frail older persons aged ≥ 75 years in the FFF intervention group (11 general practitioner (GP) practices) and in the control group receiving usual care (4 GP practices). The effectiveness measures for the cost-effectiveness and cost-utility analyses were subjective well-being (Social Production Function Instrument for the Level of well-being short; SPF-ILs) and QALYs (EuroQol; EQ-5D-3L), respectively. Costs were assessed using resource use questionnaires. Differences in mean effectiveness between groups were assessed using univariate, multilevel and propensity score matched analyses, with and without imputation of missing values. Differences in costs were assessed using Mann–Whitney U-tests and independent samples t-tests. Bootstrapping was performed, and predicted incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs) were depicted on cost-effectiveness planes. RESULTS: The various analyses showed slightly different results with respect to differences in estimated costs and effects. Multilevel analyses showed a small but significant difference between the groups for well-being, in favor of the control group. No significant differences between groups in terms of QALYs were found. Imputed data showed that mean total costs were significantly higher in the intervention group at follow-up. CONCLUSION: Proactive, integrated care for community-dwelling frail older persons as provided in the FFF program is most likely not a cost-effective initiative, compared with usual primary care in the Netherlands, in terms of well-being and QALYs over a 12-month period. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12962-019-0181-8) contains supplementary material, which is available to authorized users. BioMed Central 2019-07-09 /pmc/articles/PMC6617694/ /pubmed/31333333 http://dx.doi.org/10.1186/s12962-019-0181-8 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Vestjens, Lotte Cramm, Jane M. Birnie, Erwin Nieboer, Anna P. Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons |
title | Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons |
title_full | Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons |
title_fullStr | Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons |
title_full_unstemmed | Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons |
title_short | Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons |
title_sort | cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617694/ https://www.ncbi.nlm.nih.gov/pubmed/31333333 http://dx.doi.org/10.1186/s12962-019-0181-8 |
work_keys_str_mv | AT vestjenslotte costeffectivenessofaproactiveintegratedprimarycareapproachforcommunitydwellingfrailolderpersons AT crammjanem costeffectivenessofaproactiveintegratedprimarycareapproachforcommunitydwellingfrailolderpersons AT birnieerwin costeffectivenessofaproactiveintegratedprimarycareapproachforcommunitydwellingfrailolderpersons AT nieboerannap costeffectivenessofaproactiveintegratedprimarycareapproachforcommunitydwellingfrailolderpersons |