Incorporating frailty to address the key challenges to geriatric economic evaluation

Area of Science:

• Geriatric Medicine and Health Economics
• Development and application of frailty measures in economic modeling
• Analysis of aging processes and intervention effectiveness

Background:

• Ageing presents complex challenges for economic evaluations of geriatric interventions, including indirect effects of health shocks, non-health outcomes like caregiver burden, and population heterogeneity.
• Frailty measures aim to capture the multidimensional nature of geriatric health.
• Existing economic models for geriatric interventions face limitations in addressing these complexities.

Purpose of the Study:

• To explore how a multivariate frailty index can be incorporated into decision models to address key challenges in economic evaluation of geriatric interventions.
• To demonstrate the application of this approach using a case study of community-based falls prevention.
• To improve the accuracy and comprehensiveness of economic evaluations for interventions targeting older adults.

Main Methods:

• Developed a conceptual structure linking geriatric shocks and frailty, including shock-frailty feedback, secondary effects via frailty, and intervention access.
• Utilized the English Longitudinal Study of Ageing (ELSA) data to parameterize the model, generating a 52-item multivariate frailty index.
• Employed multivariate logistic and linear regressions, and a discrete individual simulation with annual cycles for economic modeling.

Main Results:

• Parameterised conceptual associations addressed challenges by showing how frailty progression impacts long-term health outcomes (EQ-5D-3L, mortality, costs) and how interventions can dampen feedback loops.
• The model estimated productivity gains and cost reductions (out-of-pocket, informal caregiving) by linking falls prevention to frailty.
• Frailty effectively captured heterogeneity in outcomes (EQ-5D-3L, QALY, care costs) and mediated socially inequitable distributions of frailty-associated outcomes.

Conclusions:

• The frailty-based conceptual structure and parameterization methods significantly enhance economic evaluations for geriatric interventions, particularly falls prevention.
• This approach offers a more robust framework for assessing indirect effects, societal outcomes, and population heterogeneity.
• The conceptual structure is adaptable to other geriatric and non-geriatric intervention areas, guiding future economic model development.