Cost-Effectiveness of I-CREATE: An Inpatient Intrinsic Capacity Risk Evaluation Towards Holistic Assessment and Targeted Management of Elderly in Acute Care
Author(s)
Ze Ling Nai, PhD1, Jia Ying Tang, B.S1, Poh Hoon June Teng, M.Sc1, Jia Hui Chai, MPH2, Yanan Julie Zhu, PhD2, Jie Yi Sharon Chew, B.Sc3, Hui Ni Chin, B.Sc3, Yew Yoong Ding, PhD1, Laura Tay, MBBS (Singapore)3.
1Geriatric Education and Research Institute, Singapore, Singapore, 2Singapore Clinical Research Institute, Singapore, Singapore, 3Sengkang General Hospital, Singapore, Singapore.
1Geriatric Education and Research Institute, Singapore, Singapore, 2Singapore Clinical Research Institute, Singapore, Singapore, 3Sengkang General Hospital, Singapore, Singapore.
OBJECTIVES: The I-CREATE programme is an inpatient nurse-conducted intrinsic capacity (IC) screening programme where identified IC-domain impairments - cognition, locomotion, nutrition, vision/hearing, psychology - trigger respective downstream referrals supported by multi-disciplinary discussions. This study evaluates I-CREATE’s cost-effectiveness with effectiveness measured in functional status and quality-adjusted life years (QALY) at 30-day post-discharge.
METHODS: A health-system perspective economic evaluation was embedded in a pragmatic control trial with parallel intervention (IG) and control groups (CG). Total healthcare costs include (1) program costs derived using time-driven activity-based listing and personnel norm costs, and (2) patient-level direct healthcare costs from index admission and 30-day post-discharge inpatient and emergency department visits. Surveys captured healthcare utilisation, functional status (modified Barthel index), EuroQol 5-dimension 5-level (EQ-5D-5L), demographics and health-related variables (e.g. age, gender, Charlson Comorbidity Index). Incremental differences in cost and effectiveness outcomes were calculated via regression analyses adjusting for demographic and health-related variables. The corresponding Incremental Cost Effectiveness Ratios (ICER) were compared against threshold of €87,103. We included all participants as base case. Subgroup analyses compared IG participants with/without IC-domain impairments with CG participants.
RESULTS: We surveyed 397 participants (nCG=240; nIG=157). In the base case, IG participants showed increased healthcare costs (€1,809;95%CI[679;2,940]), maintained functional status (β=0.053;95%CI[-0.600;0.706]) and improved QALY (β=0.004;95%CI[0.001;0.008]) compared to CG. Compared to CG participants, participants with no identified IC-domain impairments reported maintained healthcare costs (€323;95%CI[-1,279;1,925]), functional status (β=0.068;95%CI[-0.681;0.818) and improved QALY (β=0.005;95%CI[-0.002;0.010]). Meanwhile, IG participants with at least one identified IC-domain impairment showed increased healthcare costs (€3,388;95%CI[1,497;5,278]), maintained functional status (β=0.178;95%CI[-0.797;1.152) and QALY (β=0.003;95%CI[-0.002;0.008]) compared to CG participants.
CONCLUSIONS: Despite the improved QALYs, our ICER per QALY exceeds the threshold especially in presence of IC impairment. The general direction of improvements in functional status and QALY suggests positive benefits of the programme. However, monitoring over a longer period is needed to better assess the programme’s effectiveness and cost-effectiveness.
METHODS: A health-system perspective economic evaluation was embedded in a pragmatic control trial with parallel intervention (IG) and control groups (CG). Total healthcare costs include (1) program costs derived using time-driven activity-based listing and personnel norm costs, and (2) patient-level direct healthcare costs from index admission and 30-day post-discharge inpatient and emergency department visits. Surveys captured healthcare utilisation, functional status (modified Barthel index), EuroQol 5-dimension 5-level (EQ-5D-5L), demographics and health-related variables (e.g. age, gender, Charlson Comorbidity Index). Incremental differences in cost and effectiveness outcomes were calculated via regression analyses adjusting for demographic and health-related variables. The corresponding Incremental Cost Effectiveness Ratios (ICER) were compared against threshold of €87,103. We included all participants as base case. Subgroup analyses compared IG participants with/without IC-domain impairments with CG participants.
RESULTS: We surveyed 397 participants (nCG=240; nIG=157). In the base case, IG participants showed increased healthcare costs (€1,809;95%CI[679;2,940]), maintained functional status (β=0.053;95%CI[-0.600;0.706]) and improved QALY (β=0.004;95%CI[0.001;0.008]) compared to CG. Compared to CG participants, participants with no identified IC-domain impairments reported maintained healthcare costs (€323;95%CI[-1,279;1,925]), functional status (β=0.068;95%CI[-0.681;0.818) and improved QALY (β=0.005;95%CI[-0.002;0.010]). Meanwhile, IG participants with at least one identified IC-domain impairment showed increased healthcare costs (€3,388;95%CI[1,497;5,278]), maintained functional status (β=0.178;95%CI[-0.797;1.152) and QALY (β=0.003;95%CI[-0.002;0.008]) compared to CG participants.
CONCLUSIONS: Despite the improved QALYs, our ICER per QALY exceeds the threshold especially in presence of IC impairment. The general direction of improvements in functional status and QALY suggests positive benefits of the programme. However, monitoring over a longer period is needed to better assess the programme’s effectiveness and cost-effectiveness.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE255
Topic
Economic Evaluation, Health Service Delivery & Process of Care
Disease
Geriatrics, No Additional Disease & Conditions/Specialized Treatment Areas