Multicomponent targeted intervention to prevent delirium in hospitalized older patients - What is the economic value?

INTRODUCTION. Delirium, or acute confusional state, is a common and serious occurrence among hospitalized older persons. Current estimates suggest tha t delirium complicates hospital stays for more than 2.3 million older perso ns each year, involving more than 17.5 million hospital days and accounting for more than $4 billion (1994 dollars) of Medicare expenditures. A 40% re duction was recently reported in the risk for delirium among hospitalized o lder persons receiving a multicomponent targeted risk factor intervention ( MTI) strategy to prevent delirium, compared with subjects receiving usual h ospital care.(1) Before recommending that this preventive strategy be imple mented in clinical practice, however, the cost implications must be thoroug hly examined as well. METHODS. The present analysis performs net cost evaluations of the MTI for the prevention of delirium among hospitalized patients, Hospital charge and cost-to-charge ratio data are linked to a database of 852 subjects, who we re treated with MTI or usual care. Multivariable regression methods were us ed to help isolate the impact of MTI on hospital costs, These results were then combined with our earlier work on the impact of the MTI on delirium pr evention to assess the cost effectiveness of this intervention. RESULTS. The MTI significantly reduced nonintervention costs among subjects at intermediate risk for developing delirium, but not among subjects at hi gh risk, When MTI intervention costs were included, MTI had no significant effect on overall health care costs in the intermediate risk cohort, but ra ised overall costs in the high risk group. CONCLUSIONS. Because the MTI prevented delirium in the intermediate risk gr oup without raising costs, the conclusion reached is that it is a cost effe ctive treatment option for patients at intermediate risk for developing del irium. In contrast, the results suggest that the MTI is not cost effective for subjects at high risk.