A recent investigation into the COFRAIL intervention sheds light on its financial and health-related impacts on frail older adults managing multiple medications in Germany.
Study Overview
The cluster-randomized COFRAIL trial engaged general practitioners and 521 elderly patients dealing with polypharmacy in home care settings. Researchers aimed to determine whether structured family conferences focused on deprescribing could be cost-effective by prioritizing treatment goals.
Key Findings
The analysis considered hospital admissions prevented and quality-adjusted life years (QALYs) gained, factoring in costs from the perspective of German Social Insurance. Utilizing adjusted GLM regressions and bootstrapping techniques, the study evaluated the economic and health outcomes associated with the COFRAIL intervention compared to standard care.
- Implementation costs reached approximately €391 per patient.
- For every 100 individuals, the intervention resulted in roughly seven additional hospital admissions.
- Participants experienced an average gain of two QALYs.
- Total additional costs amounted to between €117,681 and €124,866, depending on hospital cost inclusion.
- The probability of the intervention being cost-effective stood at 46% against a €45,000/QALY threshold.
The bootstrapping analysis indicated a high likelihood of increased costs and hospital admissions, while the QALY benefits had a moderate probability of cost-effectiveness.
The COFRAIL program demonstrated a significant impact on the quality of life measurements, though this came with elevated costs and a higher rate of hospital admissions compared to usual care.
Future assessments should explore the long-term economic and health outcomes of deprescribing interventions like COFRAIL to establish a more definitive stance on their viability within primary care frameworks.
Comprehensive evaluations that extend beyond the initial 12-month period could provide deeper insights into the sustainability and broader implications of such interventions, ensuring that healthcare resources are optimally allocated to benefit the aging population.
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