Abstract Background Frailty increases vulnerability to adverse outcomes and healthcare utilization. Comprehensive geriatric assessment (CGA) improves these outcomes in high-income countries, but evidence in resource-constrained settings is limited. This study aimed to assess clinical outcomes and cost-effectiveness of two CGA models (CGA-ward; CGA-consult) compared to usual care in hospitalized frail older adults. Methods Two data sources from Siriraj Hospital were utilized: A randomized controlled trial comparing CGA-consult with usual care in acute medical wards (September 2019 and March 2024), and a retrospective cohort of patients receiving CGA-ward care in an intermediate care ward (April 2023-June 2024). Outcomes included health utility measured by EQ-5D-5L, Barthel Index, and hospital readmissions over 6 months. Cost-utility analyses were conducted from a societal perspective. Multivariate mixed-effects regression with inverse probability of treatment weighting (IPTW) estimated incremental outcomes and costs for incremental cost-effectiveness ratios (ICERs). Results Among 226 patients, 45 received CGA-ward, 89 received CGA-consult, and 92 received usual care. CGA-ward significantly improved utility scores (incremental mean: 0. 259; 95% CI: 0. 140, 0. 378) and functional outcomes (mean difference: 37. 94; 95% CI: 26. 39, 49. 48) compared to usual care. From a societal perspective, CGA-consult also showed a modest improvement in utility (incremental mean: 0. 093; 95% CI: 0. 007, 0. 179). CGA-ward and CGA-consult provided US937 and US552 savings per patient, with QALY gains of 0. 130 and 0. 047, respectively. Estimated ICERs were -US7, 208 and -US11, 745 per QALY gained, representing cost-savings for both interventions compared to usual care. Conclusions CGA-ward represents an intermediate care (IMC) model providing improved clinical and economic benefits, supporting its implementation in resource-limited settings. CGA-consult remains a viable alternative where ward-based care is not feasible, highlighting the value of integrating CGA into routine hospital care for frail older adults. Trial registration The parent randomized controlled trial was registered with the Thai Clinical Trials Registry (TCTR20190910002) on 10 September 2019.
Suraarunsumrit et al. (Wed,) studied this question.