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Integrated and PersonCentered Care for CommunityLiving Older Adults: A CostEffectiveness Study

Objectives: To assess the costeffectiveness of Embrace, an integrated primary care service for older adults.

Data Sources: Care and support claims from health care insurers, longterm care administration, and municipalities for enrolled older adults between 2011 and 2013.

Study Design: A total of 1,456 older adults, listed with 15 general practitioners practices in the Netherlands, were stratified into risk profiles (“Robust,” “Frail,” and “Complex care needs”) and randomized to Embrace or careasusual groups. Incremental costs were calculated per qualityadjusted life year, per day able to age in place, and per percentage point risk profile improvement.

Principal Findings: Total average costs were higher for Embrace compared to careasusual. Differences in healthassociated outcomes were small and not statistically significant. Probabilities that Embrace is costeffective were below 80 percent, except for “risk profile improvements” within risk profile “Complex care needs.” Complete case analysis resulted in smaller differences in total average costs across conditions and differences in healthassociated outcomes remained small.

Conclusions: According to current standards, Embrace is not considered cost effective after 12 months. However, it could be considered worthwhile in terms of “risk profile improvements” for older adults with “Complex care needs,” if society is willing to invest substantially.

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