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

dc.contributor.author

Matchar, David B

dc.contributor.author

Eom, Kirsten

dc.contributor.author

Duncan, Pamela W

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Lee, Mina

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Sim, Rita

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Sivapragasam, Nirmali R

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Lien, Christopher T

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Ong, Marcus Eng Hock

dc.date.accessioned

2021-05-05T06:39:44Z

dc.date.available

2021-05-05T06:39:44Z

dc.date.issued

2019-01

dc.date.updated

2021-05-05T06:39:43Z

dc.description.abstract

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.
dc.identifier

S0003-9993(18)31114-6

dc.identifier.issn

0003-9993

dc.identifier.issn

1532-821X

dc.identifier.uri

https://hdl.handle.net/10161/22790

dc.language

eng

dc.publisher

Elsevier BV

dc.relation.ispartof

Archives of physical medicine and rehabilitation

dc.relation.isversionof

10.1016/j.apmr.2018.07.434

dc.subject

Humans

dc.subject

Program Evaluation

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Accidental Falls

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Quality-Adjusted Life Years

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Aged

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Emergency Service, Hospital

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Cost-Benefit Analysis

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Singapore

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Female

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Male

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Physical Therapy Modalities

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Independent Living

dc.title

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

dc.type

Journal article

duke.contributor.orcid

Matchar, David B|0000-0003-3020-2108

pubs.begin-page

1

pubs.end-page

8

pubs.issue

1

pubs.organisational-group

School of Medicine

pubs.organisational-group

Duke Clinical Research Institute

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Duke Global Health Institute

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Pathology

pubs.organisational-group

Medicine, General Internal Medicine

pubs.organisational-group

Duke

pubs.organisational-group

Institutes and Centers

pubs.organisational-group

University Institutes and Centers

pubs.organisational-group

Institutes and Provost's Academic Units

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Medicine

pubs.publication-status

Published

pubs.volume

100

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