Skip to main content

Advertisement

SpringerLink
Log in

Cost-effectiveness of integrated care in frail elderly using the ICECAP-O and EQ-5D: does choice of instrument matter?

  • Original Paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

Abstract

Economic evaluations likely undervalue the benefits of interventions in populations receiving both health and social services, such as frail elderly, by measuring only health-related quality of life. For this reason, alternative preference-based instruments have been developed for economic evaluations in the elderly, such as the ICECAP-O. The aim of this paper is twofold: (1) to evaluate the cost-effectiveness using a short run time frame for an integrated care model for frail elderly, and (2) to investigate whether using a broader measure of (capability) wellbeing in an economic evaluation leads to a different outcome in terms of cost-effectiveness. We performed univariate and multivariate analyses on costs and outcomes separately. We also performed incremental net monetary benefit regressions using quality adjusted life years (QALYs) based on the ICECAP-O and EQ-5D. In terms of QALYs as measured with the EQ-5D and the ICECAP-O, there were small and insignificant differences between the instruments, due to negligible effect size. Therefore, widespread implementation of the Walcheren integrated care model would be premature based on these results. All results suggest that, using the ICECAP-O, the intervention has a higher probability of cost-effectiveness than with the EQ-5D at the same level of WTP. In case an intervention’s health and wellbeing effects are not significant, as in this study, using the ICECAP-O will not lead to a false claim of cost-effectiveness of the intervention. On the other hand, if differences in capability QALYs are meaningful and significant, the ICECAP-O may have the potential to measure broader outcomes and be more sensitive to differences between intervention and comparators.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Drummond, M.F., Sculpher, M.J., Torrance, G.W., O’Brien, B.J., Stoddart, G.L.: Methods for the economic evaluation of health care programmes, 3rd edn. Oxford University Press, Oxford (2005)

    Google Scholar 

  2. Medicare: Long-term care definition. In: vol. 04.10.2010. vol. Web page. Avaliable from http://www.medicare.gov/longtermcare/static/home.asp. Accessed 10 Apr 2013

  3. Al-Janabi, H., Flynn, T., Coast, J.: Development of a self-report measure of capability wellbeing for adults: the ICECAP-A. Qual. Life Res. 21(1), 167–176 (2012). doi:10.1007/s11136-011-9927-2

    Article  PubMed Central  PubMed  Google Scholar 

  4. Sen, A.: Choice, welfare and measurement. Harvard University Press, Cambridge (1982)

    Google Scholar 

  5. Nussbaum, M.: The quality of life. Clarendon, Oxford (1993)

    Book  Google Scholar 

  6. Brouwer, W.B.F., Culyer, A.J., van Exel, N.J.A., Rutten, F.F.H.: Welfarism vs. extra-welfarism. J. Health Econ. 27(2), 325–338 (2008). doi:10.1016/j.jhealeco.2007.07.003

    Article  PubMed  Google Scholar 

  7. Cookson, R.: QALYs and the capability approach. Health Econ. 14(8), 817–829 (2005). doi:10.1002/hec.975

    Article  PubMed  Google Scholar 

  8. Anand, P.P.: Capabilities and health. J. Med. Ethics 31(5), 299–303 (2005). doi:10.1136/jme.2004.008706pmid

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Coast, J., Flynn, T.N., Natarajan, L., Sproston, K., Lewis, J., Louviere, J.J., Peters, T.J.: Valuing the ICECAP capability index for older people. Soc. Sci. Med. 67(5), 874–882 (2008). doi:10.1016/j.socscimed.2008.05.015

    Article  PubMed  Google Scholar 

  10. Coast, J., Flynn, T., Sutton, E., Al-Janabi, H., Vosper, J., Lavender, S., Louviere, J., Peters, T.: Investigating choice experiments for preferences of older people (ICEPOP): evaluative spaces in health economics. J. Health Serv. Res. Policy 13(Suppl 3), 31–37 (2008). doi:10.1258/jhsrp.2008.008024

    Article  PubMed  Google Scholar 

  11. Makai, P., Brouwer, W.B.F., Koopmanschap, M.A., Stolk, E.A., Nieboer, A.P.: Quality of life instruments for economic evaluations in health and social care for older people: a systematic review. Soc. Sci. Med. 102, 10 (2014)

    Article  Google Scholar 

  12. Coast, J., Peters, T.J., Natarajan, L., Sproston, K., Flynn, T.: An assessment of the construct validity of the descriptive system for the ICECAP capability measure for older people. Qual. Life Res.: Int. J. Qual. Life Asp. Treat. Care Rehabil. 17(7), 967–976 (2008)

    Article  Google Scholar 

  13. Makai, P., Koopmanschap, M.A., Brouwer, W.B.F., Nieboer, A.P.: A validation of the ICECAP-O in a population of post-hospitalized older people. Health Qual. Life Outcomes 11(57), 1–11 (2013)

    Google Scholar 

  14. Makai, P., Brouwer, W.B., Koopmanschap, M.A., Nieboer, A.P.: Capabilities and quality of life in Dutch psycho-geriatric nursing homes: an exploratory study using a proxy version of the ICECAP-O. Qual. Life Res. 21(5), 801–812 (2012)

    Article  PubMed Central  PubMed  Google Scholar 

  15. Couzner, L., Ratcliffe, J., Crotty, M.: The relationship between quality of life, health and care transition: an empirical comparison in an older post-acute population. Health Qual. Life Outcomes 10(1), 69 (2012)

    Article  PubMed Central  PubMed  Google Scholar 

  16. Couzner, L., Ratcliffe, J., Lester, L., Flynn, T., Crotty, M.: Measuring and valuing quality of life for public health research: application of the ICECAP-O capability index in the Australian general population. Int. J. Public Health 58(3), 367–376 (2013)

    Article  CAS  PubMed  Google Scholar 

  17. Davis, J.C., Liu-Ambrose, T., Richardson, C.G., Bryan, S.: A comparison of the ICECAP-O with EQ-5D in a falls prevention clinical setting: Are they complements or substitutes? Qual. Life Res. 22(5), 969–977 (2013)

    Article  PubMed Central  PubMed  Google Scholar 

  18. Davis, J.C., Bryan, S., McLeod, R., Rogers, J., Khan, K., Liu-Ambrose, T.: Exploration of the association between quality of life, assessed by the EQ-5D and ICECAP-O, and falls risk, cognitive function and daily function, in older adults with mobility impairments. BMC Geriatr. 12(1), 65 (2012)

    Article  PubMed Central  PubMed  Google Scholar 

  19. Mitchell, P.M., Roberts, T.E., Barton, P.M., Pollard, B.S., Coast, J.: Predicting the ICECAP-O capability index from the WOMAC osteoarthritis index is mapping onto capability from condition-specific health status questionnaires feasible? Med. Decis. Mak. 33(4), 547–557 (2013)

    Article  Google Scholar 

  20. Comans, T.A., Peel, N.M., Gray, L.C., Scuffham, P.A.: Quality of life of older frail persons receiving a post-discharge program. Health Qual. Life Outcomes 11(1), 58 (2013)

    Article  PubMed Central  PubMed  Google Scholar 

  21. Makai, P., Beckebans, F., van Exel, J., Brouwer, W.B.: Quality of life of nursing home residents with dementia: validation of the German version of the ICECAP-O. PLoS ONE 9(3), e92016 (2014)

    Article  PubMed Central  PubMed  Google Scholar 

  22. Henderson, C., Knapp, M., Fernández, J.-L., Beecham, J., Hirani, S.P., Cartwright, M., Rixon, L., Beynon, M., Rogers, A., Bower, P., Doll, H., Fitzpatrick, R., Steventon, A., Bardsley, M., Hendy, J., Newman, S.P.: Cost effectiveness of telehealth for patients with long term conditions (whole systems demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial. BMJ 346 (2013). doi:10.1136/bmj.f1035

  23. Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D.B., McDowell, I., Mitnitski, A.: A global clinical measure of fitness and frailty in elderly people. Can. Med. Assoc. J. 173(5), 489–495 (2005). doi:10.1503/cmaj.050051

    Article  Google Scholar 

  24. Ferrucci, L., Guralnik, J.M., Studenski, S., Fried, L.P., Cutler, G.B., Walston, J.D., The Interventions on Frailty Working G: Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J. Am. Geriatr. Soc. 52(4), 625–634 (2004). doi:10.1111/j.1532-5415.2004.52174.x

    Article  PubMed  Google Scholar 

  25. Djernes, J.: Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatr. Scand. 113(5), 372–387 (2006)

    Article  CAS  PubMed  Google Scholar 

  26. Eklund, K., Wilhelmson, K.: Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomised controlled trials. Health Soc. Care Commun. 17(5), 447–458 (2009)

    Article  Google Scholar 

  27. Melis, R., van Eijken, M., Teerenstra, S., van Achterberg, T., Parker, S., Borm, G., van de Lisdonk, E., Wensing, M., Rikkert, M.: A randomized study of a multidisciplinary program to intervene on geriatric syndromes in vulnerable older people who live at home (Dutch EASYcare Study). J. Gerontol. A. 63(3), 283 (2008)

    Article  Google Scholar 

  28. Fabbricotti, I.N., Janse, B., Looman, W.M., de Kuijper, R., van Wijngaarden, J.D., Reiffers, A.: Integrated care for frail elderly compared to usual care: a study protocol of a quasi-experiment on the effects on the frail elderly, their caregivers, health professionals and health care costs. BMC Geriatr. 13(1), 31 (2013)

    Article  PubMed Central  PubMed  Google Scholar 

  29. Looman, W., Fabbricotti, I.: The effects of an integrated care model on frail elderly. Int. J. Integr. Care 12(Suppl3), e153 (2012)

    Google Scholar 

  30. Schuurmans, H., Steverink, N., Lindenberg, S., Frieswijk, N., Slaets, J.P.: Old or frail: What tells us more? J. Gerontol. A. 59(9), M962–M965 (2004)

    Article  Google Scholar 

  31. Johri, M., Beland, F., Bergman, H.: International experiments in integrated care for the elderly: a synthesis of the evidence. Int. J. Geriatr. Psychiatry 18(3), 222–235 (2003)

    Article  PubMed  Google Scholar 

  32. Schäfer, W., Kroneman, M., Boerma, W., van den Berg, M., Westert, G., Devillé, W., van Ginneken, E.: The Netherlands: health system review. Health Syst. Transit. 12(1), xxvii, 1–228 (2010)

    Google Scholar 

  33. Grewal, I., Lewis, J., Flynn, T., Brown, J., Bond, J., Coast, J.: Developing attributes for a generic quality of life measure for older people: Preferences or capabilities? Soc. Sci. Med. 62(8), 1891–1901 (2006)

    Article  PubMed  Google Scholar 

  34. Szende, A., Oppe, M.D.N.: EQ-5D value sets—inventory, comparative review and user guide, vol. 1. Springer, Dordrecht (2007)

    Book  Google Scholar 

  35. Lamers, L.M., McDonnell, J., Stalmeier, P.F.M., Krabbe, P.F.M., Busschbach, J.J.V.: The Dutch tariff: results and arguments for an effective design for national EQ-5D valuation studies. Health Econ. 15(10), 1121–1132 (2006)

    Article  CAS  PubMed  Google Scholar 

  36. Tan, S.S., Bouwmans, C.A., Rutten, F.F., Hakkaart-van Roijen, L.: Update of the Dutch manual for costing in economic evaluations. Int. J. Technol. Assess. Health Care 28(02), 152–158 (2012)

    Article  PubMed  Google Scholar 

  37. Lutomski, J.E., Baars, M.A., Kempen, J.A., Buurman, B.M., Elzen, W.P., Jansen, A.P., Kempen, G.I., Krabbe, P.F., Steunenberg, B., Steyerberg, E.W.: Validation of a frailty index from the older persons and informal caregivers survey minimum data set. J. Am. Geriatr. Soc. 61(9), 1625–1627 (2013)

    Article  PubMed  Google Scholar 

  38. Mitnitski, A.B., Mogilner, A.J., Rockwood, K.: Accumulation of deficits as a proxy measure of aging. Sci. World J. 1, 323–336 (2001)

    Article  CAS  Google Scholar 

  39. Hanmer, J., Lawrence, W.F., Anderson, J.P., Kaplan, R.M., Fryback, D.G.: Report of nationally representative values for the noninstitutionalized US adult population for 7 health-related quality-of-life scores. Med. Decis. Mak. 26(4), 391–400 (2006)

    Article  Google Scholar 

  40. Rodriguez-Blazquez, C., Forjaz, M.J., Prieto-Flores, M.E., Rojo-Perez, F., Fernandez-Mayoralas, G., Martinez-Martin, P.: Health status and well-being of older adults living in the community and in residential care settings: Are differences influenced by age? Aging Ment. Health 16(7), 884–891 (2012)

    Article  PubMed  Google Scholar 

  41. Ganiats, T.G., Miller, C.J., Kaplan, R.M.: Comparing the quality-adjusted life-year output of two treatment arms in a randomized trial. Med. Care 33(4), AS245–AS254 (1995)

    CAS  PubMed  Google Scholar 

  42. Manca, A.A., Hawkins, N., Schulpher, M.J.: Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ. 14(5), 487–496 (2005). doi:10.1002/hec.944pmid

    Article  PubMed  Google Scholar 

  43. Steiner, P.M., Cook, T.D., Shadish, W.R., Clark, M.: The importance of covariate selection in controlling for selection bias in observational studies. Psychol. Methods 15(3), 250 (2010)

    Article  PubMed  Google Scholar 

  44. Nixon, R.M., Thompson, S.G.: Methods for incorporating covariate adjustment, subgroup analysis and between-centre differences into cost-effectiveness evaluations. Health Econ. 14(12), 1217–1229 (2005)

    Article  PubMed  Google Scholar 

  45. Willan, A.R., Briggs, A.H.: Statistical analysis of cost-effectiveness data, vol. 37. Wiley, New York (2006)

    Book  Google Scholar 

  46. Hoch, J.S., Briggs, A.H., Willan, A.R.: Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ. 11(5), 415–430 (2002). doi:10.1002/hec.678

    Article  PubMed  Google Scholar 

  47. Gomes, M., Grieve, R., Nixon, R., Ng, E.S.W., Carpenter, J., Thompson, S.G.: Methods for covariate adjustment in cost-effectiveness analysis that use cluster randomised trials. Health Econ. 21(9), 1101–1118 (2012)

    Article  PubMed  Google Scholar 

  48. Pocock, S.J., Assmann, S.E., Enos, L.E., Kasten, L.E.: Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: current practice and problems. Stat. Med. 21(19), 2917–2930 (2002)

    Article  PubMed  Google Scholar 

  49. Raghunathan, T.E., Lepkowski, J.M., Van Hoewyk, J., Solenberger, P.: A multivariate technique for multiply imputing missing values using a sequence of regression models. Surv. Methodol. 27(1), 85–96 (2001)

    Google Scholar 

  50. White, I.I.R.R.P., Wood, A.M.: Multiple imputation using chained equations: issues and guidance for practice. Stat. Med. 30(4), 377–399 (2011). doi:10.1002/sim.4067pmid

    Article  PubMed  Google Scholar 

  51. Little, R.J.A., Rubin, D.B.: Statistical analysis with missing data. Wiley, New York (1987)

    Google Scholar 

  52. Gomes, M., Ng, E.S.-W., Grieve, R., Nixon, R., Carpenter, J., Thompson, S.G.: Developing appropriate methods for cost-effectiveness analysis of cluster randomized trials. Med. Decis. Mak. 32(2), 350–361 (2012)

    Article  Google Scholar 

  53. Campbell, M.K., Piaggio, G., Elbourne, D.R., Altman, D.G.: Consort 2010 statement: extension to cluster randomised trials. BMJ. 345, e5661 (2012)

    Article  PubMed  Google Scholar 

  54. Manca, A., Rice, N., Sculpher, M.J., Briggs, A.H.: Assessing generalisability by location in trial-based cost-effectiveness analysis: the use of multilevel models. Health Econ. 14(5), 471–485 (2005)

    Article  PubMed  Google Scholar 

  55. Bachmann, M.O., Fairall, L., Clark, A., Mugford, M.: Methods for analyzing cost effectiveness data from cluster randomized trials. Cost Eff. Resour. Alloc. 5(1), 12 (2007)

    Article  PubMed Central  PubMed  Google Scholar 

  56. Fenwick, E., O’Brien, B.J., Briggs, A.: Cost-effectiveness acceptability curves—facts, fallacies and frequently asked questions. Health Econ. 13(5), 405–415 (2004)

    Article  PubMed  Google Scholar 

  57. Hoch, J.S., Rockx, M.A., Krahn, A.D.: Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of. BMC Health Serv. Res. 6(1), 68 (2006)

    Article  PubMed Central  PubMed  Google Scholar 

  58. Leyrat, C., Caille, A., Donner, A., Giraudeau, B.: Propensity scores used for analysis of cluster randomized trials with selection bias: a simulation study. Stat. Med. 32, 3357–3372 (2013). doi:10.1002/sim.5795

    Article  CAS  PubMed  Google Scholar 

  59. Sumukadas, D., Witham, M.D., Struthers, A.D., McMurdo, M.E.: Effect of perindopril on physical function in elderly people with functional impairment: a randomized controlled trial. Can. Med. Assoc. J. 177(8), 867–874 (2007)

    Article  Google Scholar 

  60. Walter, S.D., Forbes, A., Chan, S., Macaskill, P., Irwig, L.: When should one adjust for measurement error in baseline variables in observational studies? Biom. J. 53(1), 28–39 (2011)

    Article  PubMed  Google Scholar 

  61. Slaets, J.P.: Vulnerability in the elderly: frailty. Med. Clin. N. Am. 90(4), 593–601 (2006)

    Article  PubMed  Google Scholar 

  62. Gobbens, R., Luijkx, K., Wijnen-Sponselee, M., Schols, J.: Towards an integral conceptual model of frailty. J. Nutr. Health Aging 14(3), 175–181 (2010)

    Article  CAS  PubMed  Google Scholar 

  63. Norman, G.R., Sloan, J.A., Wyrwich, K.W.: Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med. Care 41(5), 582–592 (2003)

    PubMed  Google Scholar 

  64. Kodner, D.L.: Consumer-directed services: lessons and implications for integrated systems of care. Int. J. Integr. Care 3, e12 (2003)

    PubMed  Google Scholar 

  65. Mur-Veeman, I., Eijkelberg, I., Spreeuwenberg, C.: How to manage the implementation of shared care—a discussion of the role of power, culture and structure in the development of shared care arrangements. J. Manag. Med. 15(2), 142–155 (2001)

    Article  CAS  PubMed  Google Scholar 

  66. Jones, D.A., Victor, C.R., Vetter, N.J.: The problem of loneliness in the elderly in the community: characteristics of those who are lonely and the factors related to loneliness. J. R. Coll. Gen. Pract 35(272), 136 (1985)

    PubMed Central  CAS  PubMed  Google Scholar 

  67. Ratcliffe, J., Laver, K., Couzner, L., Crotty, M.: Health economics and geriatrics: challenges and opportunities. Geriatrics: InTech. http://wwwintechopen.com/articles/show/title/health-economic-evaluation-and-geriatricschallenges-and-opportunities (2012)

  68. Forder, J.E., Caiels, J.: Measuring the outcomes of long-term care. Soc. Sci. Med. 73(12), 1766–1774 (2011). doi:10.1016/j.socscimed.2011.09.023

    Article  PubMed  Google Scholar 

  69. Meeuwsen, E.J., Melis, R., Adang, E., Golüke-Willemse, G., Krabbe, P., De Leest, B., Van Raak, F., Schölzel-Dorenbos, C., Visser, M., Wolfs, C.: Cost-effectiveness of post-diagnosis treatment in dementia coordinated by multidisciplinary memory clinics in comparison to treatment coordinated by general practitioners: an example of a pragmatic trial. J. Nutr. Health Aging (JNHA) 13(3), 242–248 (2009)

    Article  CAS  Google Scholar 

  70. Graff, M.J., Vernooij-Dassen, M.J., Thijssen, M., Dekker, J., Hoefnagels, W.H., Rikkert, M.G.O.: Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial. Br. Med. J. (BMJ) 333(7580), 1196 (2006)

    Article  Google Scholar 

Download references

Acknowledgments

We would like to thank Erwin Birnie and Marc Koopmanschap for their useful suggestions on a previous version of this paper. The Project is funded with a Grant from the Netherlands Organization for Health Research and Development (ZonMW; Project Number 313030201) as part of the National Care for the Elderly Program in the Netherlands (NPO). Part of the implementation of the model is also financed by the health insurer CZ.

Author information

Authors and Affiliations

  1. Department of Geriatrics, Radboud University Medical Center, Renier Postlaan 4, 6500 HB, Nijmegen, The Netherlands

    Peter Makai, Eddy Adang & René Melis

  2. Institute of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudelaan 50, 3000 DR, Rotterdam, The Netherlands

    Willemijn Looman, Elly Stolk & Isabelle Fabbricotti

Authors
  1. Peter Makai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Willemijn Looman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eddy Adang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. René Melis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elly Stolk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Isabelle Fabbricotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Makai.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Makai, P., Looman, W., Adang, E. et al. Cost-effectiveness of integrated care in frail elderly using the ICECAP-O and EQ-5D: does choice of instrument matter?. Eur J Health Econ 16, 437–450 (2015). https://doi.org/10.1007/s10198-014-0583-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-014-0583-7

Keywords

JEL Classification

Search

Navigation