A Cost-Effectiveness Analysis Of A Randomized Control Trial Of A Tailored, Multifactorial Program To Prevent Falls Among The Community-Dwelling Elderly

Publication date: Available online 27 August 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): David B. Matchar, Kirsten Eom, Pamela W. Duncan, Mina Lee, Rita Sim, Nirmali R. Sivapragasam, Christopher T. Lien, Marcus Eng Hock Ong

Abstract

Objective

To perform a cost-effectiveness analysis of a multifactorial, tailored intervention to reduce falls among a heterogeneous group of high-risk elderly.

Design

Randomized control trial

Settings

Communities

Participants

Adults aged at least 65 years (N=354) seen at the ED for a fall or fall-related injury and discharged home.

Interventions

The intervention group received a tailored program of physical therapy focused on progressive training in strength, balance, and gait for a period of 3 months. They also received screening and referrals for low vision, polypharmacy, and environmental hazards. The Short Physical Performance Battery (SPPB) test was assessed at regular intervals to allocate participants into either a home-based or group centre-based program. The control group received usual care prescribed by a physician and educational materials on falls prevention.

Main outcome measures

The incremental cost-effectiveness ratio (ICER) over the 9-month study period based on intervention costs and utility in terms of quality-adjusted life years (QALYs) calculated from EuroQol-5D scores.

Results

The ICER was S$ 120, 667 per QALY gained (S$ 362 / 0.003 QALYs), above benchmark values (S$ 70,000). However, the intervention was more effective and cost-saving among those with SPPB scores of greater than 6 at baseline, higher cognitive function, better vision and no more than 1 fall in the preceding 6 months. The intervention was also cost-effective among those with 0-1 critical comorbidities ($ 22, 646 / QALY).

Conclusion

The intervention was, overall, not cost-effective, compared to usual care. However, the program was cost-effective among healthier subgroups, and even potentially cost-saving among individuals with sufficient reserve to benefit.

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