Cost-Effectiveness of Inter-Professional Collaboration to Reduce Hospitalisations in Nursing Home Residents: Results from the German Interprof ACT Trial

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Abstract

Background:

The German multi-centre cluster-randomised controlled trial interprof ACT investigated interventions to increase inter-professional collaboration between nursing home (NH) staff and local general practitioners to reduce hospitalisations and improve nursing homes residents’ (NHRs) quality of life. The trial was funded by the German Health Care Innovation Fund.

Methods:

Cost-effectiveness of interprof ACT interventions was evaluated and compared to current standard of care (SOC) over 12 months, including 622 NHRs in 34 NHs in Germany. Multiplying resource use of healthcare services with German-specific unit costs generated costs. Health outcome was measured in quality-adjusted life-years QALYs), utility by multiplying EQ-5D-5L values with German-specific utility weights. Incremental cost-effectiveness analysis used an intention-to-treat approach and scenario analyses (SAs). Net-benefit-regression and cost-effectiveness acceptability curves addressed uncertainty. A German healthcare insurance perspective was assumed.

Results:

Base case results showed non-significant cost savings of 851.88€ and non-significant QALY loss of –0,056.

Discussion:

Dependency levels at baseline were non-significantly higher in IG compared to control group (CG). Lack of baseline costing data eliminated possibility to evaluate changes in costs due to the interprof ACT measures for both groups.

Conclusion:

Interprof ACT interventions are not cost-effective compared to current SOC.

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Most cited references 28

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Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

M. Herdman, C. Gudex, S Lloyd … (2011)

Purpose This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure. Methods EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument’s sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions. Results Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording ‘slight-moderate-severe’ problems, with anchors of ‘no problems’ and ‘unable to do’ in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states. Conclusions A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.

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Decision Modelling for Health Economic Evaluation

Andrew H Briggs, Karl Claxton, Mark J Sculpher (2006)

In financially constrained health systems across the world, increasing emphasis is being placed on the ability to demonstrate that health care interventions are not only effective, but also cost-effective. This book deals with decision modelling techniques that can be used to estimate the value for money of various interventions including medical devices, surgical procedures, diagnostic technologies, and pharmaceuticals. Particular emphasis is placed on the importance of the appropriate representation of uncertainty in the evaluative process and the implication this uncertainty has for decision making and the need for future research. This highly practical guide takes the reader through the key principles and approaches of modelling techniques. It begins with the basics of constructing different forms of the model, the population of the model with input parameter estimates, analysis of the results, and progression to the holistic view of models as a valuable tool for informing future research exercises. Case studies and exercises are supported with online templates and solutions. This book will help analysts understand the contribution of decision-analytic modelling to the evaluation of health care programmes. [Ed.]

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Is Open Access

German Value Set for the EQ-5D-5L

Kristina Ludwig, J-Matthias Graf von der Schulenburg, Wolfgang Greiner (2018)

Objectives The objective of this study was to develop a value set for EQ-5D-5L based on the societal preferences of the German population. As the first country to do so, the study design used the improved EQ-5D-5L valuation protocol 2.0 developed by the EuroQol Group, including a feedback module as internal validation and a quality control process that was missing in the first wave of EQ-5D-5L valuation studies. Methods A representative sample of the general German population (n = 1158) was interviewed using a composite time trade-off and a discrete choice experiment under close quality control. Econometric modeling was used to estimate values for all 3125 possible health states described by EQ-5D-5L. The value set was based on a hybrid model including all available information from the composite time trade-off and discrete choice experiment valuations without any exclusions due to data issues. Results The final German value set was constructed from a combination of a conditional logit model for the discrete choice experiment data and a censored at −1 Tobit model for the composite time trade-off data, correcting for heteroskedasticity. The value set had logically consistent parameter estimates (p < 0.001 for all coefficients). The predicted EQ-5D-5L index values ranged from −0.661 to 1. Conclusions This study provided values for the health states of the German version of EQ-5D-5L representing the preferences of the German population. The study successfully employed for the first time worldwide the improved protocol 2.0. The value set enables the use of the EQ-5D-5L instrument in economic evaluations and in clinical studies. Electronic supplementary material The online version of this article (10.1007/s40273-018-0615-8) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Louisa-Kristin Muntendorf:

ORCID: https://orcid.org/0000-0002-5736-2438

Journal

Journal ID (nlm-ta): Int J Integr Care

Journal ID (iso-abbrev): Int J Integr Care

Journal ID (issn): 1568-4156

Title: International Journal of Integrated Care

Publisher: Ubiquity Press

ISSN (Electronic): 1568-4156

Publication date (Electronic, pub): 19 April 2023

Publication date (Electronic, collection): Apr-Jun 2023

Volume: 23

Issue: 2

Electronic Location Identifier: 8

Affiliations

[1 ]University Medical Center Hamburg-Eppendorf, Institute of Health Services Research and Health Economics, Martinistraße 52, D-20246 Hamburg, Germany

[2 ]Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Ratzeburger Allee 160, Haus 50, D-23538 Lübeck, Germany

[3 ]Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, D-37073 Göttingen, Germany

[4 ]Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, D-37073 Göttingen, Germany

[5 ]Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany

[6 ]Department Psychology, MSH Medical School Hamburg, Am Kaiserkai 1, D-20457 Hamburg, Germany

Author notes

CORRESPONDING AUTHOR: Louisa-Kristin Muntendorf University Medical Center Hamburg-Eppendorf, Institute of Health Services Research and Health Economics, Martinistr. 52, 20246 Hamburg, Germany l.muntendorf@ 123456uke.de

Author information

Louisa-Kristin Muntendorf https://orcid.org/0000-0002-5736-2438

Katrin Balzer https://orcid.org/0000-0003-0151-2262

Tim Friede https://orcid.org/0000-0001-5347-7441

Eva Hummers https://orcid.org/0000-0003-2707-6067

Hans-Helmut König https://orcid.org/0000-0001-5711-6862

Christiane Müller https://orcid.org/0000-0002-7871-0884

Martin Scherer https://orcid.org/0000-0003-3448-9679

Britta Tetzlaff https://orcid.org/0000-0001-5532-1424

Sebastian Pfeiffer https://orcid.org/0000-0002-4458-0292

Alexander Konnopka https://orcid.org/0000-0002-2605-3456

Article

DOI: 10.5334/ijic.7001

PMC ID: 10120601

PubMed ID: 37091495

SO-VID: e1058309-b821-40da-a798-7ddcf120337c

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.

History

Date received : 04 August 2022

Date accepted : 29 March 2023

Funding

Funded by: Federal Joint Committee, doi open-funder-registry10.13039/open_funder_registry10.13039/501100014840;

Award ID: 01VSF16029

Funded by: UKE – Universitätsklinikum Hamburg-Eppendorf-, doi open-funder-registry10.13039/open_funder_registry10.13039/501100005242;

Funded by: DFG – German Research Foundation, doi open-funder-registry10.13039/open_funder_registry10.13039/501100001659;

Federal Joint Committee (Gemeinsamer Bundesausschuss), Register ID: 01VSF16029. We acknowledge financial support from the Open Access Publication Fund of UKE – Universitätsklinikum Hamburg-Eppendorf- and DFG – German Research Foundation.

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Cost-Effectiveness of Inter-Professional Collaboration to Reduce Hospitalisations in Nursing Home Residents: Results from the German Interprof ACT Trial

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Most cited references 28

Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

Decision Modelling for Health Economic Evaluation

German Value Set for the EQ-5D-5L

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