Data from: Cost-effectiveness of a specialist geriatric medical intervention for frail older people discharged from acute medical units: economic evaluation in a two-centre randomised controlled trial (AMIGOS)

Background: Poor outcomes and high resource-use are observed for frail older people discharged from acute medical units. A specialist geriatric medical intervention, to facilitate Comprehensive Geriatric Assessment, was developed to reduce the incidence of adverse outcomes and associated high resource-use in this group in the post-discharge period. Objective: To examine the costs and cost-effectiveness of a specialist geriatric medical intervention for frail older people in the 90 days following discharge from an acute medical unit, compared with standard care. Methods: Economic evaluation was conducted alongside a two-centre randomised controlled trial (AMIGOS). 433 patients (aged 70 or over) at risk of future health problems, discharged from acute medical units within 72 hours of attending hospital, were recruited in two general hospitals in Nottingham and Leicester, UK. Participants were randomised to the intervention, comprising geriatrician assessment in acute units and further specialist management, or to control where patients received no additional intervention over and above standard care. Primary outcome was incremental cost per quality adjusted life year (QALY) gained. Results: We undertook cost-effectiveness analysis for 417 patients (intervention: 205). The difference in mean adjusted QALYs gained between groups at 3 months was -0.001 (95% confidence interval [CI]: -0.009, 0.007). Total adjusted secondary and social care costs, including direct costs of the intervention, at 3 months were £4412 (€5624, $6878) and £4110 (€5239, $6408) for the intervention and standard care groups, the incremental cost was £302 (95% CI: 193, 410) [€385, $471]. The intervention was dominated by standard care with probability of 62%, and with 0% probability of cost-effectiveness (at £20,000/QALY threshold). Conclusions: The specialist geriatric medical intervention for frail older people discharged from acute medical unit was not cost-effective. Further research on designing effective and cost-effective specialist service for frail older people discharged from acute medical units is needed.

研究背景：因急性内科病房（acute medical units）出院的衰弱老年患者往往转归不佳且医疗资源消耗较高。为降低该类患者出院后不良转归的发生率及其伴随的高额资源消耗，学界开发了一项旨在推进综合老年评估（Comprehensive Geriatric Assessment）的老年专科医疗干预方案。
研究目的：对比标准照护方案，评估针对急性内科病房出院衰弱老年患者的老年专科医疗干预方案在出院后90天内的成本与成本效益。
研究方法：本研究依托一项双中心随机对照试验（randomised controlled trial, AMIGOS）开展经济学评价。研究于英国诺丁汉与莱斯特的两所综合医院开展，共纳入433名年龄≥70岁、存在未来健康风险且于就诊后72小时内从急性内科病房出院的患者。受试者被随机分配至干预组或对照组：干预组接受急性病房老年医师评估及后续专科管理，对照组仅接受标准照护，无额外干预措施。本研究的主要结局为每获得1个质量调整生命年（quality adjusted life year, QALY）所需的增量成本。
研究结果：本研究对417名患者（干预组205名）开展了成本效益分析。3个月时，两组校正后的平均获得QALYs差值为-0.001（95%置信区间[CI]：-0.009，0.007）。干预组与标准照护组3个月时校正后的二级医疗与社会照护总成本（含干预直接成本）分别为4412英镑（合5624欧元、6878美元）与4110英镑（合5239欧元、6408美元），增量成本为302英镑（95%CI：193，410）[合385欧元、471美元]。干预组被标准照护组占优的概率为62%，在£20,000/QALY的成本效益阈值下，其具备成本效益的概率为0%。
研究结论：针对急性内科病房出院衰弱老年患者的老年专科医疗干预方案并不具备成本效益。未来仍需开展进一步研究，以开发针对该类患者的高效且具成本效益的专科服务方案。