Health Economics of Frailty

Lead investigator: Professor Jon Karnon

As we learn more about frailty, funds will be required to provide effective services that are developed to delay or manage the effects of frailty. To make the case for the required funds where the overall budget situation is ‘tight’, it will be necessary to demonstrate that these services provide value for money compared to competing calls on limited healthcare budgets. Cost-effectiveness models are routinely used to demonstrate the value of patented technologies, but less so for the non-patented services of the type that may most effectively target frailty.

This project aims to develop a ‘world first’ cost-effectiveness model. The model can be used to estimate the extended cost savings and health benefits of frailty interventions in an Australian setting. This use of the model to evaluate frailty interventions will support stronger cases to be made for the funding of new services and interventions to either prevent or better manage frailty.

Progress to Date (Completed): A cohort-based state transition model was developed. The model structure includes fracture, depression, admission to aged care facilities, and death. Model inputs were estimated and calibrated using the Dynamic Analyses to Optimise Ageing dataset, supplemented with data from the published literature. A paper describing the development and validation of the model was published in Applied Health Economics and Health Policy.

Publications

Karnon J, Haji Ali Afzali H, Anggoro Putro G, et al. A cost-effectiveness model for frail older persons: Development and application to a physiotherapy-based intervention. Applied Health Economics and Health Policy 2017; 15:635-645 doi: 10.1007/s40258-017-0324-z

Media contact: Professor Jon Karnon

Lead investigators: Professors Jon Karnon and Ian Cameron

The Frailty Intervention Trial (FIT) was an early and important Australian randomized controlled trial aiming to evaluate the effectiveness of a physiotherapy-based intervention for frail persons discharged from hospitals and specialized geriatrics or rehabilitation programs. The within-trail economic evaluation showed that the intervention reduced frailty in this population, but found no significant between-group difference in quality-adjusted life years (QALYs) over the 1-year duration of the trial.

This project aims to use the cost-effectiveness model developed in Health Economics Project 1 to predict long-term cost savings and QALYs based on the differences observed within the trial.

Progress to Date (Completed): The developed cost-effectiveness model was applied to the cost-effectiveness analysis of the trial. The model-based economic evaluation showed that the frailty intervention, compared to usual care, could be cost-effective, with an expected incremental cost per QALY gained of Australian $8,129. However, there remains some uncertainty due to the size of the original clinical trial. The results were published in Applied Health Economics and Health Policy.

Publications

Karnon J, Haji Ali Afzali H, Anggoro Putro G, et al. A cost-effectiveness model for frail older persons: Development and application to a physiotherapy-based intervention. Applied Health Economics and Health Policy 2017; 15:635-645 doi: 10.1007/s40258-017-0324-z

Media contact: Professor Jon Karnon

Lead investigators: Professors Jon Karnon and and Dr Hossein Afzali

The structure of the model developed in Health Economics Project 1 represents some health states with evidence of strong associations with frailty. However, subsequent review of clinical literature showed that a more complicated cost-effectiveness model structure is needed to more accurately capture disease progression to ensure that the best possible model is used to assess the value of frailty interventions. There is scope to improve the model structure, modelling technique and model inputs. Recent guidelines for good modelling practice highlight the need for a sufficiently detailed and model development process and recommend the design of a conceptual model as a basis to inform an appropriate model structure.  A conceptual model should include important clinical states/events (e.g. fracture) and patient attributes that influence disease progression (e.g. age, gender, level of education).

This project aims to develop an improved version of the model developed in Project 1.

Progress to Date: A critical analysis of the clinical and economic literature followed by a Delphi study consisting of internationally recognised experts from the disciplines of clinical medicine and epidemiology was undertaken to inform the key components of the conceptual model. This resulted in the development of a conceptual model (as an underlying structure for a comprehensive model). After reviewing all relevant databases, and in consultation with clinical experts, the Survey of Health, Ageing and Retirement in Europe (SHARE) database was selected as the key source to populate the model. We are currently finalising the statistical analysis of the database to estimate the key model inputs. A paper describing the model structuring process was published in PharmacoEconomics. A manuscript describing the development of the conceptual model is currently under review.

Publications

Haji Ali Afzali H, Bojke L, Karnon J. Model structuring for economic evaluations of new health technologies. PharmacoEconomics 2018; 36:1309–1319.  doi: 10.1007/s40273-018-0693-7

Haji Ali Afzali H, Karnon J, Theou O. Development of a conceptual cost-effectiveness model for use in economic evaluation of frailty interventions. BMC Geriatrics (Under review)

Media contact: Dr Hossein Afzali

Lead investigators: Dr Hossein Afzali, Prof Jon Karnon, Prof Renuka Visvanathan

Emerging evidence suggest that delayed access to appropriate subsidized community-based aged care services can adversely affect health outcomes. As of the November 2018, there were approximately 115,000 people in the queue for these subsidised services.  The full economic impact of prolonged wait time prior to entry to home care packages has not been studied

Taking a health system perspective, this project aims to estimate changes in health care utilization and costs during wait time.

Progress to Date: The National Historical Cohort of the Registry of the Older South Australians (ROSA) was identified as the key data source. ROSA captures individual-based linked data including  data on the use of health care resources. An application to request data was submitted to the ROSA Research Committee.

Media contact: Dr Hossein Afzali