Cost-effectiveness of multi-component interventions to prevent delirium in older people admitted to medical wards
Open Access
- 26 January 2012
- journal article
- review article
- Published by Oxford University Press (OUP) in Age and Ageing
- Vol. 41 (3), 285-291
- https://doi.org/10.1093/ageing/afr147
Abstract
Introduction: there is evidence to suggest that delirium incidence can be reduced in older people admitted to medical services using multi-component interventions that target delirium risk factors. The cost-effectiveness of this approach is uncertain. We therefore developed a novel cost-effectiveness model for delirium prevention. Method: we compared multi-component delirium prevention intervention with usual care using a model based on a decision tree analysis. The model was used to estimate the incremental net monetary benefit (INMB). The robustness of the cost-effectiveness result was explored using deterministic and probabilistic sensitivity analyses. Result: the multi-component prevention intervention was cost-effective when compared with usual care. It was associated with an INMB of £2,200 using a cost-effectiveness threshold of £20,000 per quality-adjusted life year (QALY). It remained cost-effective in the majority of the deterministic sensitivity analyses and was cost-effective in 96.8% of the simulations carried out in the probabilistic sensitivity analysis. Discussion: our analysis has shown convincingly that multi-component prevention interventions for delirium should be considered as a cost-effective health-care strategy for medically ill people admitted to hospital. It is an attractive intervention for health-care planners as they strive to reconfigure their services to better meet the needs of an ageing population.This publication has 21 references indexed in Scilit:
- Health utilities in mild cognitive impairment and dementia: a population study in SwedenInternational Journal of Geriatric Psychiatry, 2006
- Occurrence and outcome of delirium in medical in-patients: a systematic literature reviewAge and Ageing, 2006
- Prognostic Significance of Delirium in Frail Older PeopleDementia and Geriatric Cognitive Disorders, 2005
- Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patientsCritical Care, 2005
- Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care UnitJAMA, 2004
- Delirium symptoms and low dietary intake in older inpatients are independent predictors of institutionalization: a 1-year prospective population-based study.The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 2004
- Psychiatric illness predicts poor outcome after surgery for hip fracture: a prospective cohort studyPsychological Medicine, 2000
- The risk of dementia and death after deliriumAge and Ageing, 1999
- A Multicomponent Intervention to Prevent Delirium in Hospitalized Older PatientsThe New England Journal of Medicine, 1999
- The Prognostic Significance of Delirium in Older Hospital PatientsJournal of the American Geriatrics Society, 1997