An economic evaluation of the SUNBEAM programme: a falls-prevention randomized controlled trial in residential aged care

Abstract

Objective: To estimate the cost-effectiveness of a strength and balance exercise programme (SUNBEAM) which has been shown to be clinically effective in reducing the rate of falls in residents of aged care facilities. Design: An economic evaluation was conducted alongside a pragmatic cluster randomized controlled trial that included 16 residential care facilities and 221 participants. Mean participant age was 86 years, 65% were female and 78% relied on a mobility aide. A cost-effectiveness analysis examined the costs of providing the exercise programme and costs of health service use arising from falls in each arm (intervention and usual care) over 12 months. Main measures: Incremental cost-effectiveness ratios were calculated for the cost per fall avoided. Costs were bootstrapped to obtain adjusted confidence intervals for the incremental cost-effectiveness ratios. Results: Of 63 facilities contacted, 16 met the eligibility criteria and were randomized to the intervention or usual care (1:1). There were 142 falls in the intervention group and 277 in the usual care group. 72 injurious falls occurred in the intervention group versus 157 with usual care. Delivery of the SUNBEAM programme cost $463 per participant. The mean total cost of each fall (regardless of group) was $400.09 and the mean cost of each injurious fall was $708.27. The incremental cost-effectiveness ratio was $22 per fall per person avoided with the mean bootstrapped incremental cost-effectiveness ratio $18 per fall avoided (95% CI: −$380.34 to $417.85). Conclusion: The SUNBEAM programme can be considered cost-effective, relative to other fall-prevention interventions in older adults.

Economic Evaluation of Quality Improvement Interventions Targeting Elderly Population in Long-term Care: A Scoping Review 

“…These studies originated from Canada (n = 3), United States (n = 2), United Kingdom (n = 2), Australia (n = 2) and the Netherlands (n = 2), along with one study each from Spain and Germany. The study topics represented a wide range of QI strategies such as pharmacist-led medication reviews [16][17][18][19], peer coaching for safe resident handling [20][21], preventive practices for reducing falls [22][23], preventing pressure ulcers [24][25][26], infection prevention [27][28], and dealing with challenging behaviors [29][30]. Several studies involved a multidisciplinary team, comprised of geriatricians, pharmacists, psychologists, registered nurses, licensed practical nurses, recreational therapists and care-aides working in the LTC settings.…”

“…Studies originating from Canada used a discounting rate of 3 to 5% [21,24,26], as compared to 7% in other studies originating from the United States [20], and Germany [23]. The uncertainties in the model input parameters of costs and outcome were addressed by one-way deterministic sensitivity analysis [18,[20][21][22]26,28], nonparametric bootstrapping [17], and probabilistic sensitivity analysis [16,[23][24][25]. Only two studies reported on a budget impact analysis [23,26].…”

“…The project/program implementation included costs of equipment, maintenance [18,20,24,28,30], educational package [23,29], printing and supplies [16,21,26]. The health care costs comprised of administrative staff and care-providers' salaries in the LTC facilities [18,[23][24]26], transfers to hospitals [22], in-patient hospitalization [16,18,22,23], out-patient-and-ambulatory visits including day-surgeries/procedures [16,18,[22][23]25], medical supplies and medications [16,23,28]. Only two studies reported on the societal costs (i.e., costs to the health system, as well as out-of-pocket costs and productivity losses) [21,29].…”

“…Other studies extracted diseasespeci c QALY estimates from previously published literature [23][24][25]. The QoC variables included infection prevention [27], falls or injury prevention [16,[21][22][23], reducing the length of hospital stay [24], and avoiding hospital readmissions [22]. Some studies also reported other outcomes speci c to a medical condition or disease such as cognitive improvements [18], reductions in the disease incidence or prevalence [25], preventing mortality [23][24], and reducing agitation-level [29][30].…”

“…Some studies also reported other outcomes speci c to a medical condition or disease such as cognitive improvements [18], reductions in the disease incidence or prevalence [25], preventing mortality [23][24], and reducing agitation-level [29][30]. Overall, the economic outcomes were presented as the incremental cost relative to bene t [16][17][18][22][23][24][25][29][30], net monetary bene t [20][21], and cost savings [19,26,28] or cost avoidance [4,[26][27].…”