Action Seniors! Cost‐Effectiveness Analysis of a Secondary Falls Prevention Strategy Among Community‐Dwelling Older Fallers

Abstract

BACKGROUND The Otago Exercise Program (OEP) has demonstrated cost‐effectiveness for the primary prevention of falls in a general community setting. The cost‐effectiveness of exercise as a secondary falls prevention (ie, preventing falls among those who have already fallen) strategy remains unknown. The primary objective was to estimate the cost‐effectiveness (incremental cost‐effectiveness/utility ratio) of the OEP from a healthcare system perspective. DESIGN A concurrent 12‐month prospective economic evaluation conducted alongside the Action Seniors! randomized critical trial (OEP compared with usual care). SETTING Vancouver Falls Prevention Clinic (Vancouver, BC, Canada; http://http://www.fallsclinic.ca). PARTICIPANTS A total of 344 community‐dwelling older adults, aged 70 years and older, who attended a geriatrician‐led Falls Prevention Clinic in Vancouver, after sustaining a fall in the previous 12 months. MEASUREMENTS Main outcome measures included: incidence rate ratio for falls, healthcare costs, incremental cost per fall prevented, and incremental cost per quality‐adjusted life year (QALY) gained. RESULTS The OEP costs $393 CAD per participant to implement. The incremental cost per fall prevented resulted in a savings of $2 CAD. The incremental cost per QALY gained (where QALYs were estimated using the Euro‐Qol 5D three‐level version [EQ‐5D‐3L]) indicated the OEP was less effective than usual care. The incremental cost per QALY gained (where QALYs were estimated using the Short Form 6D [SF‐6D]) indicated the OEP was more effective and less costly than usual care. The incremental QALYs estimated using the EQ‐5D‐3L and the SF‐6D were not clinically significant and close to zero, indicating no change in quality of life. CONCLUSION Compared with usual care, healthcare system costs are saved and falls are prevented when older fallers who attend a geriatrician‐led falls clinic are allocated to, and provided, the physiotherapist‐guided exercise‐based falls prevention program (the OEP).

Comparing the cost-effectiveness of the Otago Exercise Programme among older women and men: A secondary analysis of a randomized controlled trial

“…This is a secondary analysis of a randomized clinical trial with a concurrent economic evaluation that examined the cost-effectiveness and cost-utility of the OEP, stratified by women and men. The study protocol, principal randomized clinical trial findings and primary economic evaluation findings are published [ 14 , 21 , 22 ].…”

“…Health resource utilization data were not imputed due to the high percentage of complete data obtained [ 38 ]. Unit costs for healthcare cost items were previously reported [ 21 ]. A unit cost from the British Columbia Medical Serviced Plan ( https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/msp/physicians/payment-schedules/msc-payment-schedule ) 2018 fee for service price list was assigned for each component of HRU.…”

“…The OEP is a cost-effective primary and cost-effective secondary prevention strategy [ 12 , 13 , 21 ] [ 21 ]. However, whether the OEP is cost-effective for both women and men is unknown.…”

Economic evaluations of fall prevention exercise programs: a systematic review

“…We found a total of 20 economic evaluations reported in 21 articles, 9 trial-based [29][30][31][32][33][34][35][36][37]…”

“…Summary of results of the intervention costs of fall prevention exercise programs for older adults living in the community Davis et al29 , Canada (HI) †; Davis et al37 , Canada (HI) † Robertson et al34 (1), New Zealand (HI)*; Robertson et al36 (2), New Zealand (HI) †; Robertson et al35 (3), New Zealand (HI) †; Hektoen et al44 , Norway (HI) †; Church et al49 , Australia (HI) ‡; Church et al39 , Australia (HI) ‡; Deverall et al41 , New Zealand (HI) ‡; Frick et al43 , USA (HI) ‡, Mori et al47 , USA (HI) ‡ This table only includes studies where the intervention was powered for falls and had a significant impact on falls. Results for model-based, trial-based and costing studies are presented together.…”