M.PEREIRA1, E.CHONG2, J.MOLINA1, S.NG1, E.GOH2, B.ZHU2, M.CHAN2, W.S.LIM2
National Healthcare Group HQ1, Tan Tock Seng Hospital2
Early geriatric interventions at the emergency department (ED) can reduce acute admissions. We aimed to perform a cost-effectiveness analysis (CEA) of delivering the EDIFY programme at the front-door.
This CEA was conducted alongside a quasi-experimental study. Recruited older patients pending acute admissions from the ED were assigned EDIFY or standard care (SC). Bills from the ED attendance, including subsequent admission if applicable, were obtained. Average incremental EDIFY cost was estimated. Health-related quality-of-life was measured using a utility tool (EQ-5D-5L) over 6 months. A crosswalk method was done to compute localised index scores from EQ-5D-5L responses, used to calculate quality-adjusted life-years (QALYs) gained during the study. Multiple imputation (MI) was performed for missing data. Seemingly unrelated regressions modelled main CEA. The potential extent of parameter, sampling, imputation, modelling and methodological uncertainties were examined.
Among 100 participants (EDIFY=43; controls=57), 61 provided complete data. Mean bills were obtained (EDIFY=SGD$4562.7; controls=SGD$5530.9). EDIFY’s average incremental cost approximated SGD$469.3. Unadjusted EDIFY QALYs gained ranged 0.018 to 0.089, and for controls, -0.018 to 0.006. In the complete case CEA, whilst costs were similar between-groups, there were significant 3-month QALYs gained for EDIFY patients (coefficient=0.032, p=0.004) and overall (coefficient=0.096, p=0.002). For MI, we observed only overall QALYs gained for EDIFY (coefficient=0.102, p=0.001). In a deterministic sensitivity analysis, maximum EDIFY cost-threshold was SGD$2,500, and main conclusions were largely consistent in other uncertainty scenarios.
EDIFY can potentially be considered future SC for older adults attending the ED. It is cost-effective, with equivalent costs as current SC, and greater QALY benefits.