Cost‐Effectiveness of Family Conferences to Reduce Polypharmacy in Frail Older Adults

TL;DR

This study evaluates whether family conferences to reduce polypharmacy in frail older adults are cost-effective, finding mixed results with higher costs and uncertain long-term benefits.

Contribution

The study is the first to assess the cost-effectiveness of family conferences for deprescribing in frail older adults with polypharmacy.

Findings

The COFRAIL intervention increased costs and QALYs but had a 46% probability of being cost-effective at €45,000/QALY.

Family conferences were associated with more hospital admissions and uncertain long-term cost-effectiveness.

Intervention costs were €391 per capita, with additional costs of €50,966 per QALY gained.

Abstract

Cost‐effectiveness of family conferences on deprescribing with joint prioritization of treatment goals in primary care has not been investigated so far. We assessed cost‐effectiveness in the cluster‐randomized controlled COFRAIL trial conducted with general practitioners and 521 older frail patients with polypharmacy cared for at home in Germany.

Hospital admissions averted and quality‐adjusted life years (QALYs) gained were associated with costs from the German Social Insurance perspective. We applied adjusted GLM regressions with specified distributions to estimate group differences on imputed data, plotted bootstrap cost‐outcome pairs by simulated resampling of the study population to illustrate uncertainty and calculate the probability of cost‐effectiveness given a willingness‐to‐pay threshold, and assessed robustness in sensitivity analyses.

Intervention‐related costs were €391 (US$459) per capita. On 100 people, the COFRAIL intervention had about 7 more hospital admissions (95% CI: −12; 26), 2 QALYs gained (95% CI: −1; 6), and additional costs of €117,681 (95% CI: −28,838; 264,201)/US$138,027 (95% CI: −33,824; 309,880) or €124,866 (95% CI: −12,649; 262,380)/US$146,455 (95% CI: −14,836; 307,745) without or with hospital costs, respectively, compared to usual care. By bootstrapping, we observed the COFRAIL intervention to have higher costs and more hospital admissions with a relative frequency of 28%–78%, or in terms of QALYs 57%–91%. The COFRAIL intervention had additional costs of €50,966 (US$59.778) per QALY gained with a 46% probability of being cost‐effective at a willingness to pay of €45,000/QALY (≈US$50,000/QALY).

The COFRAIL intervention affected QALYs rather than hospital admissions after 12 months. The intervention tended to be associated with higher costs and QALYs but was less likely to be cost‐effective than usual care at commonly used willingness‐to‐pay thresholds. Long‐term cost‐effectiveness should be assessed.

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