Online ISSN: 1099-176X Print
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Return on Investment of the Primary Health Care Integrated Geriatric Services Initiative Implementation
Nguyen X. Thanh,1 Tanmay Patil,2 Charlene Knudsen,3 Sharon N. Hamlin,4 Helen Lightfoot,5 Heather M. Hanson,6 Dennis Cleaver,7 Karenn Chan,8 James Silvius,9 Scott Oddie,10 Scott Fielding11
1MD, MPH, PhD, Alberta Health Services,
& University of Alberta, Edmonton, Alberta, Canada
* Correspondence to: Nguyen Xuan Thanh,
Research Scientist, Strategic Clinical Networks, Alberta Health Services,
Alberta, Canada, 2-103 South Tower, Seventh Street Plaza, 10030 107 St.
Edmonton, Alberta, Canada, T5J 3E4.
Tel.: +1-780-735 1664
Fax: +1-780-735 0237
Source of Funding: None declared.
|We used a cohort design together with a difference-in-difference approach and a propensity-score-matching technique to evaluate impacts of the Primary Health Care Integrated Geriatric Services Initiative (PHC IGSI) on health service utilization and associated costs of people with dementia living in communities in Alberta, Canada. The results demonstrated the intervention reduced hospital services utilization by increasing community services utilization. As hospital services are expensive, the PHC IGSI resulted in a net cost-saving from CAD 554 to 4,046 per patient for the health system, and a Return of Investment (ROI) ratio from 1.3 to 3.1 (every CAD invested in PHC IGSI would return CAD 1.3 to 3.1). The probability of PHC IGSI being cost-saving was 56.4% to 69.3%. The savings would be larger if PHC IGSI is sustained, scaled up and spread because of not only a reduced cost of intervention in the sustainability phase, but also of an increased number of patients impacted.|
Background: Since June 2017, the Primary Health Care Integrated Geriatric Services Initiative (PHC IGSI) has been implemented in Alberta, Canada to, among other aims, reduce costs of unplanned health service utilization while maximizing the utilization of available community resources to support people living with dementia living in communities.
Aim of the Study: We performed an economic evaluation of this initiative to inform policy regarding sustainability, scale up and spread.
Methods: We used a cohort design together with a difference-in-difference approach and a propensity score matching technique to calculate impacts of the intervention on patient's health service utilization, including inpatient, outpatient and physician services, as well as prescription drugs. We then used a decision tree to compare between benefits and costs of the intervention and reported net benefits (NB) and return on investment ratios (ROI). We used a health system perspective and a time horizon of 1 year. Both deterministic and probabilistic sensitivity analyses were performed for the uncertainty of parameters. We analyzed real-world data extracted from the Alberta Health Administrative Databases. All costs/savings were inflated to 2019 CAD (CAD 1 \sim = USD 0.75) using the Canadian Consumer Price Index.
Results: The intervention reduced the use of hospital (inpatient, emergency, and outpatient) services by increasing the use of community services (physician and prescription drug). As hospital services are expensive, the PHC IGSI community intervention resulted in a NB from CAD 554 to 4,046 per patient-year for the health system, and a ROI from 1.3 to 3.1 meaning that every CAD invested in PHC IGSI would bring CAD 1.3 to 3.1 in return. The probability of PHC IGSI to be cost-saving was 56.4% to 69.3%.
Implications for Health Care Provision and Use: The PHC IGSI is cost-effective in Alberta.
Implications for Health Policy: The savings would be larger if the initiative is sustained, scaled up and spread because of not only a reduced cost of intervention in the sustainability phase, but also because of the increased number of patients that would be impacted.
Implications for Further Research: Future studies taking a societal perspective to also include costs for families and health and social sectors at the community level, would be desirable. Additionally, future works to determine how wellbeing is impacted by the PHC IGSI as vertical and horizontal integration interventions are implemented at the community level, are essential to undertake. Finally, in addition to people living with dementia, the PHC IGSI also supports people living in the community with frailty and other geriatric syndromes, therefore, the cost-savings estimated in this study are likely underestimated.
Received 21 April 2020; accepted 23 July 2020
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