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Home visits for the elderly

Home visits for the elderly. Klas Göran Sahlén Klasse.sahlen@epiph.umu.se. P reventive H ome V isits: A successful strategy or a waste of money? Do we have reasons to believe that interventions as PHV are cost-effective?. Outline. The balance: costs-effectiveness.

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Home visits for the elderly

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  1. Home visits for the elderly Klas Göran Sahlén Klasse.sahlen@epiph.umu.se

  2. Preventive Home Visits: A successful strategy or a waste of money? Do we have reasons to believe that interventions as PHV are cost-effective? Outline

  3. The balance: costs-effectiveness Health gains due to preventive home visits in Nordmaling. Costs for the intervention minus savings caused by the same trial

  4. The target group • Seniors aged 75 years and more • No home help • Living in their homes • 600 seniors

  5. 600 seniors Intervention group Control group 350 seniors • 250 were invited to participate • 200 accepted Design • Followed the intervention group • Related the intervention group to the control group • Comprehensive analysis of drop outs

  6. 2 visits / year Every visit was 1,5 – 3 hours Preventive home visits

  7. Conversation life style medical information risk awareness “someone care” Preventive home visits

  8. Staff (118 T€) Material (3 T€) Buildings (7 T€) Participant’s time ( ) SUM: 148 T€ Intervention costs

  9. Description of time windows used to calculate costs and savings. From: Sahlén et al . Preventive home visits to older people are cost effective. Scand J Public Health 2008;36:265-271

  10. How changes / results differ over time From: Sahlén et al . Preventive home visits to older people are cost effective. Scand J Public Health 2008;36:265-271

  11. Results • Mortality decreased ( IRR 2,31 ) • Emergency visits in PHC decreased • Influenza vaccine increased • Home help decreased • Seniors own judgments improved (Sahlen et al. BMC Public Health, 2006, 6:220)

  12. The balance Costs for the intervention minus savings caused by the same trial If two year 152.000 € If lifetime and future health care 891.000 € If four years -129.000 €

  13. The balance Costs for the intervention minus savings caused by the same trial Health gains due to preventive home visits in Nordmaling. If two year 11 gained years If lifetime 91 gained years If four years 32 gained years

  14. The cost-effectiveness balance Costs for the intervention minus savings caused by the same trial Health gains due to preventive home visits in Nordmaling. If two year 8 gained QALY’s If lifetime 63 gained QALY’s If four years 22 gained QALY’s

  15. Is this a presentation of an intervention when costs and effects are in balance? Two years: 8 QALY’s gained and 152.000 € 100’ €/QALY Four years: 22 QALY’s gained and -129.000 € 50’ €/QALY If lifetime 63 QALY’s gained 20100 € and 891.000 € 14 200 € 0 €/QALY

  16. Is this a presentation of an intervention when costs and effects are in balance? Conclusion ”the spent money were well used ”

  17. The risk of illness is high The incentives for participation is significant The cost for time is low Are results reasonable?

  18. Different opinions on the effects • Different target groups • Different content • The educational background of the visitor differ • Different context • Different definitions ∞

  19. Implementation - problems • “Can you report the results to me, next year” • “We can give all information during visit one” • “This is a good task for Mary, with her pain” • “We can do it this way………..”

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