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Cost-benefit analysis of implementing comprehensive geriatric assessment enhanced shared decision making into aortic
David Buxton1,2, Andy Healey3, Bijan Modarai4,5
1Department of General Medicine, Alfred Health, Melbourne, Victoria, Australia.
Age and Ageing
|December 19, 2025
Summary
Implementing comprehensive geriatric assessment (CGA) with shared decision making (SDM) in aortic aneurysm repair pathways reduces costs. This approach improves patient selection, leading to significant departmental savings and better outcomes.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Health Economics
Background:
- Aortic aneurysm repair is increasingly considered for frail patients.
- Identifying suitable candidates for surgery is challenging.
- Comprehensive geriatric assessment (CGA) and shared decision making (SDM) can improve patient selection and outcomes.
Purpose of the Study:
- To model the marginal cost impact of implementing universal CGA enhanced SDM into standard preoperative pathways.
- To evaluate the cost-effectiveness of improved patient selection in aortic aneurysm repair.
Main Methods:
- A decision-based model was developed to compare net costs.
- Two scenarios used local and national data.
- Sensitivity and breakeven analyses were performed.
Main Results:
- CGA costs were offset by savings from increased non-operative management.
- Cost-benefit was estimated at £821-£907 per referral.
- A 2.9%-3.1% reduction in surgical management offset intervention costs.
Conclusions:
- Routine CGA enhanced SDM in aortic aneurysm pathways reduces total departmental costs.
- This integrated approach optimizes resource allocation.
- Improved patient selection through CGA and SDM is cost-effective.
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