Cost-effectiveness of emergency department-based vs mobile geriatric care models for older patients

Older adults, with complex needs and an elevated risk of complications, account for a high proportion of emergency visits in France. Mobile geriatric teams (MGTs) and the emergency geriatric medicine unit (EGMU) based in the emergency department (ED) have been developed to improve care. Although the EGMU reduces hospitalizations and readmissions, its cost-effectiveness remains uncertain. This study assessed the incremental cost-effectiveness ratio (ICER) of the EGMU compared to the MGT unit. In all, 338 older patients were included: 102 managed by the MGT unit in January 2014 and 236 in the EGMU in January 2015, which replaced the MGT unit. The primary efficacy endpoint was the rate of readmission to the ED within 30 days (30DRA). We conducted the analysis from the payer’s perspective, incorporated a Monte Carlo simulation, and generated a cost-effectiveness acceptability curve. The average cost per patient was estimated to be €5,738.16 in the EGMU, compared to €6,701.35 in the MGT unit. The mean 30DRA was 0.09 for the EGMU and 0.13 for the MGT unit. The ICER was €24,079 per readmission avoided (RA). The probability that the EGMU would be cost-effective at a willingness-to-pay threshold of €33,622.84 per RA was 63.26%. The EGMU appears to be more efficient than the MGT unit, reducing 30DRA and average costs, although further studies are needed to confirm these findings.