Cost-Utility of Geriatric Assessment and Management in Older Adults With Cancer: Model-Based Economic Evaluation.

Abstract

PURPOSE Geriatric assessment and management (GAM) is a guideline-recommended strategy for optimizing cancer management among older adults. A recent cost-utility analysis of the Canadian 5C randomized controlled trial (RCT) found GAM to be cost effective for selected groups. This study aimed to assess the cost-utility of GAM plus usual care (UC) versus UC alone in older adults with cancer using a decision model and best available evidence from four international RCTs-GAIN, GAP70, INTEGERATE, and 5C. METHODS For the model, we used pooled data from four RCTs and peer-reviewed literature. Deterministic and probabilistic analyses were performed from the Canadian health care payer perspective, applying a 6-month time horizon. Sensitivity analyses included per-trial scenario analyses, 1-year time horizon, and US health care payer perspective. We reported costs per quality-adjusted life year (QALY) and incremental net monetary benefit (INMB). RESULTS The base-case analysis indicated that GAM had an INMB of $599 in Canadian dollars (CAD; 95% credibility interval, -$3,428 to $4,742) with 60.9% probability of being cost effective at a threshold of $50,000 (CAD) per QALY. Trial-specific results varied, with the GAP70 and INTEGERATE trials yielding positive INMB ($2,231 [CAD] and $2,104 [CAD], respectively), suggesting cost-effectiveness, whereas 5C and GAIN resulted in negative INMB (-$489 [CAD] and -$234 [CAD], respectively). Chemotherapy and hospitalization costs were the main driver of costs in both strategies. CONCLUSION GAM is overall cost effective, with results varying across trial scenarios due to differences in chemotherapy dose intensity, hospitalization rates, and associated costs. Future research should prioritize identifying optimal core GAM components, delivery mode, and patient selection criteria to enhance its effectiveness and cost-effectiveness.