Summary of findings for the main comparison. Comprehensive geriatric assessment (CGA) versus admission to hospital without CGA.
| Comprehensive geriatric assessment (CGA) versus admission to hospital without CGA | |||||
| Patient or population: older adults admitted to hospital Setting: unplanned hospital admissions in 9 largely high‐income countries Intervention: CGA Comparison: usual care | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | |
| Risk with usual care | Risk with CGA | ||||
| Living at home (end of follow‐up 3 to 12 months) | Study population | RR 1.06 (1.01 to 1.10) | 6799 (16 RTs) | ⊕⊕⊕⊕ HIGH | |
| 561 per 1000 | 595 per 1000 (567 to 617) | ||||
| Mortality (end of follow‐up 3 to 12 months) | Study population | RR 1.00 (0.93 to 1.07) | 10,023 (21 RTs) | ⊕⊕⊕⊕ HIGH | |
| 230 per 1000 | 230 per 1000 (214 to 247) | ||||
| Admission to a nursing home (end of follow‐up 3 to 12 months) | Study population | RR 0.80 (0.72 to 0.89) | 6285 (14 RTs) | ⊕⊕⊕⊕ HIGH | |
| 186 per 1000 | 151 per 1000 (136 to 169) | ||||
| Dependence | Study population | RR 0.97 (0.89 to 1.04) | 6551 (14 RTs) | ⊕⊕⊕⊕ HIGH | |
| 291 per 1000 | 282 per 1000 (259 to 302) | ||||
| Cognitive function | Standardised mean difference ranged from ‐0.22 to 0.35. | ‐ | 3534 (5 RTs) | ⊕⊕⊝⊝ LOWa, | |
| Length of stay | Not estimable Mean length of stay in the control group ranged from 1.8 days to 42.8 days. |
Mean length of stay in the intervention group ranged from 1.63 days to 40.7 days. | ‐ | 5303 (17 RTs) | ⊕⊕⊝⊝ LOWa, |
| Cost and cost‐effectiveness | Healthcare costs per participant in the CGA group were on average GBP 234 (95% CI GBP ‐144 to GBP 605) higher than in the usual care group (17 trials); CGA led to 0.012 (95% CI ‐0.024 to 0.048) more QALYs (3 trials), 0.037 (95% CI 0.001 to 0.073) more LYs (4 trials), and 0.019 (95% CI ‐0.019 to 0.155) more LYLAH (2 trials) per participant. Costs per QALYs gained was GBP 19,802, per LY gained was GBP 6305, and per LYLAH gained was GBP 12,568. CGA was more costly in 89% of 10,000 generated ICERs and led to QALY gains in 66% of cases, LY gains in 87% of cases, and LYLAH gains in 74% of cases. The probability that CGA would be cost‐effective at a GBP 20,000 ceiling ratio for QALY, LY, and LYLAH was 0.50, 0.89, and 0.47, respectively. | 5303 (17 RTs) | ⊕⊕⊝⊝ LOWa, |
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| *The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CGA: comprehensive geriatric assessment: CI: confidence interval; ICER: incremental cost‐effectiveness ratio; LY: life year; LYLAH: life year living at home; OR: odds ratio; QALY: quality‐adjusted life year; RR: risk ratio; RT: randomised trial. | |||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to the estimate of effect. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | |||||
aThe evidence was downgraded due to imprecision and substantial heterogeneity