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 | |
dc.contributor.author | Lee, Mina | |
dc.contributor.author | Sim, Rita | |
dc.contributor.author | Sivapragasam, Nirmali R | |
dc.contributor.author | Lien, Christopher T | |
dc.contributor.author | 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 | ObjectiveTo perform a cost-effectiveness analysis of a multifactorial, tailored intervention to reduce falls among a heterogeneous group of high-risk elderly people.DesignRandomized control trial.SettingsCommunities.ParticipantsAdults aged at least 65 years (N=354) seen at the emergency department (ED) for a fall or fall-related injury and discharged home.InterventionsThe 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 measuresThe 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.ResultsThe 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).ConclusionThe 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 | ||
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 | |
dc.subject | Accidental Falls | |
dc.subject | Quality-Adjusted Life Years | |
dc.subject | Aged | |
dc.subject | Emergency Service, Hospital | |
dc.subject | Cost-Benefit Analysis | |
dc.subject | Singapore | |
dc.subject | Female | |
dc.subject | Male | |
dc.subject | Physical Therapy Modalities | |
dc.subject | 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 | |
pubs.organisational-group | Duke Global Health Institute | |
pubs.organisational-group | 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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