Cost-effectiveness of multidisciplinary transitional care interventions: A systematic review and meta-analysis

BACKGROUND: Multidisciplinary transitional care interventions promote care coordination after hospital discharge and address (older) patients' complex care needs related to their physical, nutritional, and/or psychosocial status. OBJECTIVE: This review aimed to identify, critically appraise, and synthesize evidence on the cost-effectiveness of multidisciplinary transitional care interventions compared to usual care. DESIGN: Systematic review and meta-analysis. SETTING(S): Hospitals and primary care. PARTICIPANTS: Adult patients admitted to a hospital, regardless of their condition, and discharged home. METHODS: Medline, Embase, CINAHL, and CENTRAL were searched for randomized controlled trials assessing multidisciplinary transitional care interventions' cost-effectiveness compared to usual care and reporting quality of life or quality-adjusted life years (QALY) from inception to July 2024. Findings were stratified by economic perspective and follow-up duration. Evidence certainty was assessed using Grading of Recommendations Assessment, Development, and Evaluation. The primary outcome was the incremental net monetary benefit (expressed as mean difference). Cost-effectiveness acceptability curves depicted probabilities of cost-effectiveness at various willingness-to-pay thresholds. RESULTS: Thirteen trials, containing 4114 patients, were included. From a healthcare perspective over 12 months, there was "low" certainty that multidisciplinary transitional care interventions reduced healthcare costs (MD, €-3452; 95 % CI, -8816 to 1912) while there was no difference in QALYs (MD, 0.00; 95 % CI, -0.03 to 0.04) compared to usual care. The probability of cost-effectiveness over 12 months was 90 % at a willingness-to-pay of €0/QALY, decreasing slightly to 84 % at higher willingness-to-pay thresholds ("moderate" certainty). Over six months, cost-effectiveness probabilities ranged from 43 % at €0/QALY to 87 % at €100,000/QALY, exceeding 80 % at a willingness to pay of €50,000/QALY ("low" to "moderate" certainty). From a societal perspective, the probabilities of cost-effectiveness were lower, primarily due to a limited number of studies with conflicting results. CONCLUSIONS: Multidisciplinary transitional care interventions demonstrate potential for cost-effectiveness. However, the "low" evidence certainty of most comparisons underscores the need for further research to explore the cost-effectiveness of different types of multidisciplinary transitional care interventions across patient populations and country income levels to identify the most cost-effective strategies. REGISTRATION: The review protocol was registered on PROSPERO, CRD42023421423.