Clinical Effectiveness Evaluation and Cost-effectiveness Analysis of Comprehensive Geriatric Assessment and Multidisciplinary Team for Ambulatory Older Patients: A Cohort Study

Prakasit  Virulhakul; Somboon  Intalapaporn; Sichon   Luerithipong; Narisa  Tantai; Satanan  Maneeon; Weerasak Muangpaisan

doi:10.33192/smj.v77i1.271623

Authors

Prakasit Virulhakul Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Somboon Intalapaporn Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Sichon Luerithipong Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Narisa Tantai Pharmacy Department, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Satanan Maneeon Pharmacy Department, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Weerasak Muangpaisan Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v77i1.271623

Keywords:

clinical effectiveness evaluation, cost-effectiveness, incremental cost-effectiveness, comprehensive geriatric assessment, multidisciplinary team, geriatric clinic

Abstract

Objective: The comprehensive geriatric assessment (CGA) and multidisciplinary team (MDT) services are essential components of clinics that promote holistic care for older patients. However, their clinical and cost-effectiveness have not been fully established.

Materials and Methods: This study was a 1-year cohort, two-arm observational study conducted in ambulatory older patients at the Geriatric and Internal Medicine OPD. The primary endpoint was clinical effectiveness: activity of daily living (ADL), Thai mental status examination (TMSE), Mini-nutritional assessment (MNA), extra-visit, hospitalization, length of stay, fall rate, and death rate. The secondary endpoint was a cost-utility analysis using a decision-tree and Markov model. Outcomes included the incremental cost-effectiveness ratio (ICER), and quality of life, assessed by the European Quality of Life Five Dimensions Five Levels (EQ-5D-5L). Sensitivity analysis was conducted through probabilistic methods.

Results: Older adults who received the CGA and MDT service in the geriatric OPD showed improved nutritional status, with the MNA-SF score increasing from 9.3 (± 3.3) to 10.9 (± 2.9) (p=0.01). There were no significant differences between groups in terms of extra-visits, hospitalizations, length of stay, fall rate, or death rate. After one year, the ICER for the CGA and MDT group was US$-3,073 per quality-adjusted life year (QALY) gained to usual care, indicating cost savings at a threshold of $4, 564.9 US dollar per QALY gained.

Conclusion: The CGA and MDT service in a geriatric clinic is clinically effective compared to usual care over a one-year follow-up, as demonstrated by the improvement in nutritional status. Additionally, the CGA and MDT is a cost-saving intervention.

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