Cost-effectiveness of comprehensive geriatric assessment: systematic review of economic evaluations

BACKGROUND: Comprehensive geriatric assessment (CGA) can be resource-intensive as its delivery involves multidisciplinary personnel, multidimensional assessment, care planning and follow-up. The aim of this systematic review is to appraise and synthesise evidence on the cost-effectiveness of CGA across settings. METHODS: Full economic evaluation studies examining CGA were searched across five databases. We included studies involving adults aged ≥65 years who were identified as living with frailty or at risk of adverse outcomes. Two independent reviewers screened studies against eligibility criteria and extracted data using a pretested extraction form. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards framework. We reported the results through narrative summaries, tables and figures. RESULTS: A total of 4864 studies were identified, of which 17 were included across 7 settings (11 community, 6 hospital). Of 13 cost-utility analysis studies, incremental quality-adjusted life years ranged from -0.06 to 0.54 and incremental costs ranged from €-12 744 to €29 785. The probability CGA was cost-effective ranged from 0% to 98.9% across stated willingness-to-pay thresholds (cost-effective in 5/13, not cost-effective in 7/13, 50% chance in 1/13). Two studies showed that cost-effectiveness can vary by frailty severity and residential status. The resource intensity of CGA varied, ranging from 25% (case management protocol) to 81% (comprehensive assessment). Only five studies accounted for informal caregiver costs. The reporting quality ranged from 38% to 90%. CONCLUSION: The cost-effectiveness of CGA remains uncertain. Variations in resource intensity of CGA, frailty severity, residential status of older adults and setting may explain this heterogeneity. PROSPERO REGISTRATION NO: CRD42023492586.