THE SEPULVEDA GEU STUDY REVISITED - LONG-TERM OUTCOMES, USE OF SERVICES, AND COSTS

The randomized controlled trial of the Geriatric Evaluation Unit (GEU) at the Sepulveda Veterans Hospital was the first to document the clin ical and cost-effectiveness of hospital-based comprehensive geriatric assessment (CGA). Frail elderly inpatients were assigned randomly to t he GEU for CGA, therapy, rehabilitation, and placement (N=63), or to s tandard hospital care (N=60). At one year, GEU patients had much lower mortality (24% vs 48%) and were less likely to have been discharged t o a nursing home (NH) (13% vs 30%), or to have spent any time in NHs ( 27% vs 47%). GEU patients were more likely to improve in personal self -maintenance and morale. Further, controls had substantially more acut e-care hospital days, NH days, and hospital readmissions, resulting in higher direct institutional care costs, especially after survival adj ustment. Here, we report the results of long-term follow-up. There was a significant survival effect through two years. Despite prolongation of life, there was no indication that quality of life was worse for s urvivors in the GEU group. In fact, the proportion of persons independ ent in greater than or equal to 12 ADLs at two years was somewhat high er for GEU patients (0.44) than controls (0.33) (z=1.27; p=0.056). By three years, 43% of GEU subjects and 38% of controls were still alive. Over the entire 3-year period, the per capita direct cost difference was not significant, either before or after survival adjustment (unadj usted: $37,091 GEU vs $34,205 control; survival-adjusted: $54,315 GEU vs $63,362 control; p=0.17). For patients who died during follow-up, t he per capita health-care costs of the last year of life were signific antly lower in GEU than control decedents ($28,337 vs $38,494; p=0.01) . We conclude that the beneficial effects of the GEU persisted at leas t to 2 years, and that GEU and associated aftercare did not inflate ca re costs and was cost-effective over the long term.