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

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.