Geriatric Helpline Services to Improve Health and Care Pathways in Older Adults: A Cost-Effectiveness Analysis.

Background and Aims: Hospitalization has hugely damaging effects on the ability of older adults to live independently, and therefore warrants preventive interventions. Here we report on an experimental geriatric helpline intervention to help general practitioners and hospital-based nongeriatric care professionals improve quality of care for older adults. The objective is to calculate the cost-effectiveness ratio of geriatric helplines implemented. Methods: An observational, multicentre study was conducted in France between April 2018 and 2020 at seven hospitals. We analyzed helpline calls made by general practitioners or hospital physicians, concerning community-dwelling or assisted-living older adults aged 75 years old and above. A social-value cost-effectiveness analysis was performed, and an incremental cost-effectiveness ratio (ICER) was calculated. Data on mismatches between call and response were kept for analysis where we calculated the costs incurred for "call: advice - response: hospitalization" mismatches, and the costs avoided for "call: hospitalization - response: advice" mismatches. A multivariate sensitivity analysis was performed on several scenarios. Results: On the 4611 calls to the helplines, 4137 were analyzed and there were 257 "call: advice - response: hospitalization" mismatches and 537 "call: hospitalization - response: advice" mismatches which were kept for the cost-effectiveness analysis. The geriatric helpline was cost-effective, with an ICER equal to €2565 per mismatch avoided ranged between €1769 and €3896. Sensitivity analysis showed that the geriatric helpline costed €145,487 in the worst scenario or avoided €4,643,127 in the best scenario. Modeling for a 1-year working geriatric helpline showed that results are robust. Conclusions: This new organization of geriatric care intervention is cost-effective but depends on the motive for calling distribution and the "call: advice - response: hospitalization" mismatches. The full-time geriatrician is easily financed by the cost savings made. Trial Registration: ClinicalTrials.gov: NCT03959475.