Cost-effectiveness of outpatient geriatric assessment with an interventionto increase adherence

BACKGROUND. Comprehensive geriatric assessment (CGA) can be effective in in patient units, but such inpatient settings are prohibitively expensive. If similar benefits could be obtained in outpatient settings, CGA might be a m ore attractive option. OBJECTIVES. To assess the cost-effectiveness (CE) of an outpatient geriatri c assessment with an intervention to increase adherence. SUBJECTS. Three hundred fifty-one community-dwelling, elderly subjects with at least one of four geriatric conditions. MEASURES. In addition to the measures of functioning, we collected data on the costs of the intervention itself and on the use of medical services in the 64 weeks after the intervention. RESULTS. The intervention, which prevented functional decline, cost $273 pe r participant. The intervention group averaged three more visits than the c ontrol group in the first 32 weeks after the intervention, but only 1.2 ext ra visits in the next 32 weeks. We estimate that the costs of these additio nal medical services would be $473 for the 5 years alter the intervention, leading to a total cost per Quality Adjusted Life Year (QALY) of $10,600. CONCLUSIONS. The CE of this program compares favorably with many common med ical interventions. Whether investments should be made in health care resou rces on treatments that lead tot modest improvements in the functioning of community-dwelling elderly people remains a societal decision.