TY  - JOUR
PY  - 2019//
TI  - A cost-effectiveness analysis of a randomized control trial of a tailored, multifactorial program to prevent falls among the community-dwelling elderly
JO  - Archives of physical medicine and rehabilitation
A1  - Matchar, David B.
A1  - Eom, Kirsten
A1  - Duncan, Pamela W.
A1  - Lee, Mina
A1  - Sim, Rita
A1  - Sivapragasam, Nirmali R.
A1  - Lien, Christopher T.
A1  - Hock Ong, Marcus Eng
SP  - 1
EP  - 8
VL  - 100
IS  - 1
N2  - OBJECTIVE: To perform a cost-effectiveness analysis of a multifactorial, tailored intervention to reduce falls among a heterogeneous group of high-risk elderly. <br><br>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. <br><br>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). <br><br>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.<br><br>Copyright © 2018. Published by Elsevier Inc.<p />  <p>Language: en</p>
LA  - en
SN  - 0003-9993
UR  - http://dx.doi.org/10.1016/j.apmr.2018.07.434
ID  - ref1
ER  -