Economic evaluation of a multimodal intervention in pre-frail and frail older people with diabetes mellitus: the MID-FRAIL project

ABSTRACT

Background: The aim of this study was to estimate the incremental cost-utility ratio (ICUR) of a multi-modal intervention in frail and pre-frail subjects aged ≥70 years with type-2 diabetes versus usual care group focused on quality adjusted life years (QALYs) in different European countries.

Methods: The MID-FRAIL study was a cluster randomized multicentre trial conducted in seven European countries. A cost-utility analysis was carried out based on this study, conducted from the perspective of the health care system with a time horizon of one year. Univariate and probabilistic analysis were carried out to test the robustness of the results.

Results: The cost estimation showed the offsetting health effect of the intervention program on total health care costs. The mean annual health care costs were 25% higher among patients in usual care. The mean incremental QALY gained per patient by the intervention group were 0.053 QALY compared with usual care practice.

Conclusions: The MID-FRAIL intervention program showed to be the dominant option in comparison with usual care practice. It saved costs to the health care system and achieved worthwhile health gains. This finding should encourage its implementation, at least, in the trial participant countries.

KEYWORDS:

• Diabetes
• T2DM
• frailty
• older people
• health care costs
• cost-utility
• economic evaluation
• multimodal intervention

Article highlights

• This is the first economic evaluation focused on QALYs performed over a multimodal intervention on frail older subjects with type-2 diabetes across Europe.

• The MIDFRAIL intervention (clinical targets, physical activity plus nutritional education) leads to a better health status and lower health care costs, being a dominant option over usual care practice.

• Our study sheds light on the favorable results that might be derived from the implementation of such an intervention in real clinical practice.

Authors’ contributions

LP, JO, and NZ carried out the analysis. MT made the probabilistic analysis. LP and JO wrote the first draft of the manuscript. All the authors reviewed and made comments and suggestions for the manuscript and agreed with the final outcome.

Consent for publication

Authors consent for publication.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Ethical Approval and Consent to participate

Not applicable.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Availability of data and material

Data and material could be available upon request and consent of the coordinators.

Additional information

Funding

This paper was funded by the European Commission [H2020].