Edwin Geleijn, Judith Bosmans, Marike van der Leeden, Marike van der Schaaf, Romain Collet, Charlotte Groenewoud, Raymond Ostelo, Juul van Grootel, Suzanne Wiertsema, Mel Major, Johanna van Dongen
Journal: International journal of nursing studies 2025;168():105103
PMID: 40394777
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.
Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.
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