Moving Beyond Quality-Adjusted Life-Years in Elderly Care: How Can Multicriteria Decision Analysis Complement Cost-Effectiveness Analysis in Local-Level Decision Making

Maaike Hoedemakers*, Apostolos Tsiachristas, Maureen Rutten-van Mölken

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
55 Downloads (Pure)

Abstract

Objectives: This study aimed to investigate how multicriteria decision analysis (MCDA) could complement cost-effectiveness analysis (CEA) to support investment decisions in elderly care at local level. Methods: We used an integrated elderly care program in The Netherlands as a case study to demonstrate the application of both methods. In a 12-month quasi-experimental study (n = 384), data on the following outcome measures were collected: quality-adjusted life-years (CEA) and physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person centeredness, continuity of care, and costs (MCDA). We performed regression analysis on inversed probability weighted data and controlled for potential confounders to obtain a double robust estimate of the outcomes. Probabilistic sensitivity analyses determined uncertainty for both methods. Results: The integrated elderly care program was not likely (ie, 36%) to be cost-effective according to the CEA (incremental cost-effectiveness ratios: €88 249 from a societal perspective) using the conventional Dutch willingness-to-pay threshold (ie, €50 000). The MCDA demonstrated that informal caregivers and professionals slightly preferred the intervention over usual care, driven by enjoyment of life and person centeredness. Patients did not prefer either the intervention or usual care, whereas payers and policy makers slightly preferred usual care, mainly due to higher costs of the intervention. Conclusions: MCDA could provide local-level decision makers with a broader measurement of effectiveness by including outcomes beyond health and longevity and the preferences of multiple stakeholders. This additional information could foster the acceptability and implementability of cost-effective innovations in elderly care.

Original languageEnglish
Pages (from-to)1717-1725
Number of pages9
JournalValue in Health
Volume25
Issue number10
Early online date25 May 2022
DOIs
Publication statusPublished - Oct 2022

Bibliographical note

Funding Information:
Funding/Support: The SELFIE project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement no. 634288. The content of this manuscript reflects only the SELFIE group's views and the European Commission is not liable for any use that may be made of the information contained herein.

Funding Information:
Funding/Support: The SELFIE project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement no. 634288 . The content of this manuscript reflects only the SELFIE group’s views and the European Commission is not liable for any use that may be made of the information contained herein.

Publisher Copyright:
© 2022 International Society for Pharmacoeconomics and Outcomes Research, Inc.

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