Health economic perspective on a community-based intervention for older people at risk of care dependency - results of a prospective quasi-experimental study

David Lampe; Lena Hasemann; Thomas Nebling; Ulrich Thiem; Wolfgang Greiner

doi:10.1177/23337214221140222

Health economic perspective on a community-based intervention for older people at risk of care dependency - results of a prospective quasi-experimental study

Gerontol Geriatr Med. 2022 Nov 23:8:23337214221140222. doi: 10.1177/23337214221140222. eCollection 2022 Jan-Dec.

Authors

David Lampe^{1

2

3

4}, Lena Hasemann¹, Thomas Nebling², Ulrich Thiem^{3

4}, Wolfgang Greiner¹

Affiliations

¹ AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Bielefeld, Germany.
² Techniker Krankenkasse, Department Care Management, Hamburg, Germany.
³ Centre for Geriatrics and Gerontology, Albertinen-Haus, Hamburg, Germany.
⁴ University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Abstract

This prospective, quasi-experimental study aims to compare healthcare resource utilization (HCRU) and costs of a multi-component care approach for older people in a community setting (intervention group (IG)) with usual care in a matched control group (CG) during a 21-month observation period. The reablement-oriented intervention included a geriatric assessment, a case and network management and digital supporting tools. Regression models were applied to determine intervention effects regarding hospitalization, total hospital length of stay (LOS), number of physician consultations, and healthcare costs using claims data. 872 subjects were included in the IG and 1,768 in the CG. The analyses showed that the intervention did not affect hospitalization (OR = 1.153; 95% CI: 0.971-1.369, p = .105). However, participating in the IG lead to a small but significant increase of physician contacts by a factor of 1.078 (Exp(ß) = 1.078; 95% CI: 1.011-1.149; p = .022). A non-significant mean difference in costs of €1,183 (95% CI: €-261.6 to €2,627.6, p = .108) per participant was identified. Further research is needed to generate robust evidence on the optimal design of care approaches for older people and the health economic implications of such interventions to improve care and resource allocation decision-making. Trial registration: The study was registered at the German Clinical Trials Register (DRKS00027866).

Keywords: complex intervention; health care costs; healthcare resource utilization; multi-component community-based care approach; reablement.