Unit costs (in 2019 € prices).

BackgroundOver 65s are frequent attenders to the Emergency Department (ED) and more than half are admitted for overnight stays. Early assessment and intervention by a dedicated ED-based Health and Social Care Professionals (HSCP) team reduces ED length of stay and the risk of hospital admissions among older adults while improving patient health-related quality-of-life and satisfaction with care. This study aims to evaluate whether augmenting the treatment as usual for older adults admitted to ED is cost-effective.Methods and findingsCost-effectiveness analysis (CEA), conducted alongside the OPTI-MEND randomised controlled trial of 353 patients aged ≥65 with lower urgency complaints compared the effectiveness of early assessment and intervention by a dedicated HSCP team in the ED to treatment as usual (TAU). An economic analysis estimated the average cost per older adults randomised to the HSCP team, and compared to TAU, how contact with HSCP team changed health care use, and associated total costs, and estimated the effect of HSCP on Quality-Adjusted Life Years (QALYs). Within the OPTI-MEND trial, the average cost of a contact with the HSCP team during ED attendance is estimated to be €801 per patient. Compared to TAU, the incremental QALY of intervention is 0.053 (95% CI: 0.023 to 0.0826, pConclusionsA dedicated HSCP team in the ED significantly improves overall health for lower acuity older adults and, by reducing inpatient length of stay, results in staggering cost savings. This economic evaluation conducted on the OPTI-MEND trial provides convincing evidence that HSCP should be adopted as part of treatment as usual in Irish EDs.Trial registrationClinicalTrials.gov, NCT03739515; registered on 12th November 2018. https://classic.clinicaltrials.gov/ct2/show/NCT03739515.

【背景】65岁及以上人群为急诊室（Emergency Department，ED）高频就诊群体，其中超半数需留院过夜。由急诊专职卫生与社会照护专业人员（Health and Social Care Professionals，HSCP）团队实施的早期评估与干预，可缩短老年患者的急诊停留时长，降低其住院收治风险，同时提升患者的健康相关生活质量与护理满意度。本研究旨在评估，针对急诊收治的老年患者，在常规治疗基础上追加HSCP团队干预是否具备成本效益。

【方法与结果】本研究依托OPT-I-MEND随机对照试验开展成本效益分析（Cost-effectiveness analysis，CEA），共纳入353名年龄≥65岁、主诉低危的患者，对比急诊专职HSCP团队早期评估干预与常规治疗（treatment as usual，TAU）的临床效果。经济评估环节估算了随机分配至HSCP团队组的每位老年患者的平均成本，对比TAU组，分析HSCP团队干预对医疗服务使用情况、相关总费用的影响，并评估了HSCP干预对质量调整生命年（Quality-Adjusted Life Years，QALYs）的作用。在OPT-I-MEND试验中，急诊就诊期间接受HSCP团队干预的患者平均成本为每人801欧元。与TAU组相比，干预组的增量质量调整生命年为0.053（95%置信区间：0.023至0.0826，p）

【结论】急诊专职HSCP团队可显著改善低危老年患者的整体健康状况，通过缩短住院停留时长实现可观的成本节约。本研究基于OPT-I-MEND试验开展的经济评估，提供了充分证据支持：应将HSCP团队服务纳入爱尔兰急诊室的常规治疗体系。

【试验注册】该试验在ClinicalTrials.gov注册，编号为NCT03739515，注册日期为2018年11月12日，注册网址：https://classic.clinicaltrials.gov/ct2/show/NCT03739515。