Substudy 10 Executive Summary

Substudy 10: The Cost-Effectiveness of Geriatric Day Hospitals

by Réjean Hébert and Johanne Desrosiers

Rationale for the Study

Given the costs and uncertain effectiveness of a geriatric day hospital (GDH), there is a need for additional economic evaluations. The goal of Substudy 10 of the National Evaluation of the Cost-Effectiveness of Home Care project was to investigate whether the benefit related to a geriatric day hospital (GDH) program exceeded the costs using a cost-benefit analysis based on functional autonomy changes.

Key Findings

Substudy 10 demonstrated that in our convenience sample composed of elderly people living at home and presenting an average functional autonomy score of 17.9 on the SMAF scale and admitted to a GDH program, the benefit outweighed costs by 114% ($1 dollar invested = $2.14 of benefit; 95%CI: $1.72-2.56). This estimate relies only on functional autonomy changes and must be viewed as the lower limit of the global benefit of the GDH program. Other studies should be done to duplicate our results to compare the benefit related to a GDH with the benefit related to no or a different intervention.

Implications

The results of this study give policy makers more information on the economical aspects of a GDH program for their decisions about budget allocation for the health care of the elderly. From the societal point of view, this report suggests that it is efficient to allocate resources to GDH programs for elderly who have a decrease of functional autonomy.

Methodology/Data Collection

The sample was composed of 151 patients admitted to the GDH program at the Sherbrooke University Geriatrics Institute (SUGI) in the Province of Quebec, Canada. Data from a previous longitudinal study tracking autonomy changes in 607 elderly people over 75 years of age living at home were used to create a comparison group. Clinical data collection. After admission to (T0) and at discharge (T1) from the GDH program, functional autonomy was assessed by a trained nurse using the Système de Mesure de l'Autonomie Fonctionnelle (SMAF). Based on financial reports, costs associated with resources consumed by the GDH program were established. Benefit in dollars per day was estimated through regression equations based on functional autonomy changes T1-T0 related to the GDH program. A scenario for spreading the benefit per day was proposed: the median time from survival analysis to institutionalization or death from the comparison group.

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