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

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

doi:https://doi.org/10.1371/journal.pone.0175272

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

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

Research output: Contribution to journal › Article › Academic › peer-review

9 Citations (Scopus)

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 (sic) 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

Original language	English
Article number	4
Pages (from-to)	e0175272
Journal	PLOS ONE
Volume	12
Issue number	4
DOIs	https://doi.org/10.1371/journal.pone.0175272 https://doi.org/10.1371/journalpone.0175272
Publication status	Published - 2017

Keywords

Activities of Daily Living
Aged
Aged, 80 and over
Cluster Analysis
Community Health Nursing
Cost-Benefit Analysis
Disabled Persons
Economics, Nursing
Female
Geriatric Assessment
Health Care Costs
Health Services for the Aged
Humans
Journal Article
Male
Models, Economic
Models, Nursing
Netherlands
Nursing Care
Quality-Adjusted Life Years
Randomized Controlled Trial

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Suijker, J. J., MacNeil-Vroomen, J. L., van Rijn, M., Buurman, B. M., de Rooij, S. E., Moll van Charante, E. P., & Bosmans, J. E. (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, 12(4), e0175272. Article 4. https://doi.org/10.1371/journal.pone.0175272, https://doi.org/10.1371/journalpone.0175272

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

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 (sic) 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",

keywords = "Activities of Daily Living, Aged, Aged, 80 and over, Cluster Analysis, Community Health Nursing, Cost-Benefit Analysis, Disabled Persons, Economics, Nursing, Female, Geriatric Assessment, Health Care Costs, Health Services for the Aged, Humans, Journal Article, Male, Models, Economic, Models, Nursing, Netherlands, Nursing Care, Quality-Adjusted Life Years, Randomized Controlled Trial",

author = "Suijker, {Jacqueline J.} and MacNeil-Vroomen, {Janet L.} and {van Rijn}, Marjon and Buurman, {Bianca M.} and {de Rooij}, {Sophia E.} and {Moll van Charante}, {Eric P.} and Bosmans, {Judith E.}",

year = "2017",

doi = "https://doi.org/10.1371/journal.pone.0175272",

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pages = "e0175272",

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number = "4",

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Suijker, JJ, MacNeil-Vroomen, JL , van Rijn, M, Buurman, BM, de Rooij, SE, Moll van Charante, EP & Bosmans, JE 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, vol. 12, no. 4, 4, pp. e0175272. https://doi.org/10.1371/journal.pone.0175272, https://doi.org/10.1371/journalpone.0175272

Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: results of a cluster randomized trial. / Suijker, Jacqueline J.; MacNeil-Vroomen, Janet L.; van Rijn, Marjon et al.
In: PLOS ONE, Vol. 12, No. 4, 4, 2017, p. e0175272.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people

T2 - results of a cluster randomized trial

AU - Suijker, Jacqueline J.

AU - MacNeil-Vroomen, Janet L.

AU - van Rijn, Marjon

AU - Buurman, Bianca M.

AU - de Rooij, Sophia E.

AU - Moll van Charante, Eric P.

AU - Bosmans, Judith E.

PY - 2017

Y1 - 2017

N2 - 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 (sic) 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

AB - 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 (sic) 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

KW - Activities of Daily Living

KW - Aged

KW - Aged, 80 and over

KW - Cluster Analysis

KW - Community Health Nursing

KW - Cost-Benefit Analysis

KW - Disabled Persons

KW - Economics, Nursing

KW - Female

KW - Geriatric Assessment

KW - Health Care Costs

KW - Health Services for the Aged

KW - Humans

KW - Journal Article

KW - Male

KW - Models, Economic

KW - Models, Nursing

KW - Netherlands

KW - Nursing Care

KW - Quality-Adjusted Life Years

KW - Randomized Controlled Trial

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DO - https://doi.org/10.1371/journal.pone.0175272

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SN - 1932-6203

VL - 12

SP - e0175272

JO - PLOS ONE

JF - PLOS ONE

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Suijker JJ, MacNeil-Vroomen JL , van Rijn M, Buurman BM, de Rooij SE, Moll van Charante EP et al. 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. 2017;12(4):e0175272. 4. doi: https://doi.org/10.1371/journal.pone.0175272, https://doi.org/10.1371/journalpone.0175272

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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Keywords

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