Abstract
BackgroundTo evaluate the effects of a case management intervention for frail older people (aged 65+ years) by cost and utility.Materials and methodsOne hundred and fifty-three frail older people living at home were randomly assigned to either an intervention (n = 80) or a control group (n = 73). The 1-year intervention was carried out by nurses and physiotherapists working as case managers, who undertook home visits at least once a month. Differences in costs and quality-adjusted life years (QALYs) based on the health-related quality-of-life instruments EQ-5D and EQ-VAS, and also the incremental cost-effectiveness ratio were investigated. All analyses used the intention-to-treat principle.ResultsThere were no significant differences between the intervention group and control group for total cost, EQ-5D-based QALY or EQ-VAS-based QALY for the 1-year study. Incremental cost-effectiveness ratio was not conducted because no significant differences were found for either EQ-5D- or EQ-VAS-based QALY, or costs. However, the intervention group had significantly lower levels of informal care and help with instrumental activities of daily living both as costs (€3,927 vs. €6,550, p = 0.037) and provided hours (200 vs. 333 hours per year, p = 0.037).ConclusionsThe intervention was cost neutral and does not seem to have affected health-related quality of life for the 1-year study, which may be because the follow-up period was too short. The intervention seems to have reduced hours and cost of informal care and help required with instrumental activities of daily living. This suggests that the intervention provides relief to informal caregivers.
Highlights
To evaluate the effects of a case management intervention for frail older people by cost and utility
There were no significant differences between the intervention group and control group for total cost, EQ-5D-based quality-adjusted life years (QALYs) or EQ-VAS-based QALY for the 1-year study
Incremental cost-effectiveness ratio was not conducted because no significant differences were found for either EQ-5D- or EQ-VAS-based QALY, or costs
Summary
To evaluate the effects of a case management intervention for frail older people (aged 65+ years) by cost and utility. Sandberg et al Health Economics Review (2015) 5:12 the effects on the participants. Comprehensive health economic evaluations looking at both costs and utility gained for the individual are necessary to determine whether an intervention should be implemented. It could be challenging to evaluate [9] To deal with these challenges, the British Medical Research Council has developed a framework for evaluating complex interventions [9] that suggests a multi-step approach including a development phase, feasibility/piloting, evaluation (preferably through a randomised controlled trial) and implementation. Its guidance states that an economic evaluation is important to determine cost effectiveness of a complex intervention and whether it should be implemented
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