3 ORIGINAL ARTICLE ABSTRACT Aim: to investigate the cost effectiveness of CGA in an acute geriatric ward. Methods: a non-randomized controlled trial was carried out at Dr. Cipto Mangunkusumo General Hospital from January to December 2005. The inclusion criteria were elderly patients with geriatric syndrome. Exclusion criteria were advanced malignancy, APACHE II score > 34, in-hospital mortality in the rst 24 hours, move to another ward before completing CGA management, the presence of dementia. After patients were allocated into CGA and non-CGA group, effectiveness was assessed using ADL/WHO- Unescap score, days of hospitalization, proportion of re-hospitalization, survival, quality of life score (EQ5D), patients and nurses satisfaction score. Cost effectiveness analysis was done using TreeAge-Pro 2004 software program. Results: the length of hospitalization was shorter in the CGA group than in non-CGA group (10.99 [0.79] days vs. 20.16 [2.62] days; p=0.00). At the end of treatment, mean of ADL score changes was signicantly higher in CGA group than non-CGA group. Mean of WHO-Unescap score changes in CGA group was higher than non-CGA group (0.71[0.04] vs 0.61 [0.04]; p=0.09). EQ5D-VAS score was also higher in CGA group (0.79[0,01] vs 0.75[0.01]; p=0,01). Survival proportion in CGA group was lower than non-CGA group (80.37% vs 86.92%; p>0.05). Rehospitalization proportion was higher in non-CGA group than in CGA group (21.5% vs 11.21%; p 0.04). Patient’s satisfaction level was higher in CGA group (193.38 [1.25] vs 177.47 [3.04]; p=0.00). Nurse satisfaction level was also higher in CGA group than non-CGA group but not statistically signicant (225.06[7.08] vs 220.06[8.26]; p=0.65). Mean of healthcare cost in non-CGA group was higher than in CGA group (Rp. 9,746,426.00 [1,180,331] vs Rp 4,760,965.00 [338,089]). Cost effectiveness analysis indicated that CGA was superior to conventional approach because for each point score of QALD’s, total cost was The Impact of ‘Comprehensive Geriatric Assessment (CGA)’ Implementation on The Effectiveness and Cost (CEA) of Healthcare in an Acute Geriatric Ward Czeresna Heriawan Soejono Department of Internal Medicine, Faculty of Medicine University of Indonesia-dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro No. 71, Jakarta. E-mail: geriatri_fkuirscm@yahoo.com lower in geriatric acute care unit than in conventional ward (Rp 418,199.00 vs Rp 628,695.00). Moreover, QALD’s in CGA group was better than in non-CGA group (24.1 vs 22.8; p= 0.03). Conclusion: the CGA approach is more cost effective compared to conventional approach. Quality adjusted life days are better in CGA group than in non-CGA group although survival is not statistically different. In CGA group, length of hospitalization was shorter, functional status and patient satisfaction is better in general. Working satisfaction of nurses in CGA group was not lower than in non CGA group. Key words: approach, comprehensive, geriatric, cost- effectiveness, quality-adjusted life days. INTRODUCTION Demographic transition is currently taking place in Indonesia. The proportion of the elderly is increasing in number due to decreased total fertility rate and infant mortality rate. The total number of elderly population will increase signicantly, by 414% in 35 years. In 2010, the elderly population whose age is more than 60 years in Indonesia is predicted at approximately 19 million. 1 Demographic transition will implicate in epidemiologic transition. The incidence of chronic degenerative disease and malignancy will be increasing. Common diseases in elderly will be more frequently found in common practice. Geriatric patients and their unique characteristics will be more frequently seeking help from doctors. The characteristics of geriatric patient are, i.e., multi pathologic, non specific clinical symptoms, limited physiologic reserved capacity, functional status changes and frequently accompanied deranged nutritional status. Psychosocial status is often a burden for geriatric patients and their family. 2-5 This complexity and challenging health problems of elderly urgently need special approach called comprehensive geriatric assessment (CGA).