A Cost-Effectiveness Analysis of a Randomized Control Trial of a Tailored, Multifactorial Program to Prevent Falls Among the Community-Dwelling Elderly.

Published

Journal Article

OBJECTIVE:To perform a cost-effectiveness analysis of a multifactorial, tailored intervention to reduce falls among a heterogeneous group of high-risk elderly people. DESIGN:Randomized control trial. SETTINGS:Communities. PARTICIPANTS:Adults aged at least 65 years (N=354) seen at the emergency department (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 center-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 120,667 Singapore dollars (S$) 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 (S$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.

Full Text

Duke Authors

Cited Authors

  • Matchar, DB; Eom, K; Duncan, PW; Lee, M; Sim, R; Sivapragasam, NR; Lien, CT; Ong, MEH

Published Date

  • January 2019

Published In

Volume / Issue

  • 100 / 1

Start / End Page

  • 1 - 8

PubMed ID

  • 30165053

Pubmed Central ID

  • 30165053

Electronic International Standard Serial Number (EISSN)

  • 1532-821X

International Standard Serial Number (ISSN)

  • 0003-9993

Digital Object Identifier (DOI)

  • 10.1016/j.apmr.2018.07.434

Language

  • eng