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PLoS One. 2019 Sep 11;14(9):e0222049. doi: 10.1371/journal.pone.0222049. eCollection 2019.

Structuring a conceptual model for cost-effectiveness analysis of frailty interventions.

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College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Torrens University, Adelaide, South Australia, Australia.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.



Frailty is a major health issue which impacts the life of older people, posing a significant challenge to the health system. One of the key emerging areas is the development of frailty interventions to halt or reverse the progression of the condition. In many countries, economic evidence is required to inform public funding decisions for such interventions, and cost-effectiveness models are needed to estimate long-term costs and effects. Such models should capture current clinical understanding of frailty, its progression and its health consequences. The objective of this paper is to present a conceptual model of frailty that can be used to inform the development of a cost-effectiveness model to evaluate frailty interventions.


After critical analysis of the clinical and economic literature, a Delphi study consisting of experts from the disciplines of clinical medicine and epidemiology was undertaken to inform the key components of the conceptual model. We also identified relevant databases that can be used to populate and validate the model.


A list of significant health states/events for which frailty is a strong independent risk factor was identified (e.g., hip fracture, hospital admission, delirium, death). We also identified a list of important patient attributes that may influence disease progression (e.g., age, gender, previous hospital admissions, depression). A number of large-scale relevant databases were also identified to populate and validate the cost-effectiveness model. Face validity of model structure was confirmed by experts.


The proposed conceptual model is being used as a basis for developing a new cost-effectiveness model to estimate lifetime costs and outcomes associated with a range of frailty interventions. Using an appropriate model structure, which more accurately reflects the natural history of frailty, will improve model transparency and accuracy. This will ultimately lead to better informed public funding decisions around interventions to manage frailty.

Conflict of interest statement

The authors have declared that no competing interests exist.

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