Cost-Effectiveness and Cost-Utility of a Multidisciplinary Falls Prevention Program in Community-Dwelling Elderly People
Year: 2006
Type: preprint
Abstract: Falls are common among elderly people. About one-third of people over the age of 65 fall at least once a year. Falls can be caused by many different risk factors, intrinsic and extrinsic. Consequences of falls are divers and vary from fractures, loss of mobility, and functional decline to for example fear of falling and loss of autonomy. Therefore, falls can have a considerable impact on quality of life. Furthermore, people who have fallen show an increase in morbidity and healthcare utilization, which often results in excessive healthcare costs. Because the divers causes and consequences of falls, economic evaluations on falls prevention in elderly people should be performed from a broad societal perspective. This paper discusses the results of the economic evaluation embedded in a two-group randomized controlled trial to evaluate the effects of a multidisciplinary intervention program to prevent new falls among elderly people in the Netherlands. The aim was to assess whether the multidisciplinary intervention programme is preferable to usual care in terms of costs and effects when assessed from a societal perspective. The program was aimed at community-dwelling elderly people aged 65 years or over who have visited an accident and emergency department because of a fall. The intervention program consisted of a detailed medical and occupational therapy assessment to identify risk factors for falling and was followed by recommendations and referral to relevant services if indicated. People in the control group received usual care. A combined cost-effectiveness and cost-utility analysis was performed from a societal perspective, which implies that all costs and outcomes were taken into account where possible. Falls (fall calendar) and healthcare utilization (cost diary) were measured continuously during twelve months of follow-up. Daily Functioning (Frenchai Activity Index), generic quality of life (Euroqol -5D) and specific quality of life (Falls Handicap Inventory) were measured at baseline, after four and twelve months. A sensitivity analysis was done to assess the generalizability of the assumptions made in the costing process. Finally, bootstrap analyses were performed to estimate the uncertainty of the findings. A total of 166 participants were allocated to the experimental group and 167 in the control group. The overall response rate was 74%. At baseline there were no differences between the two groups on the main characteristics. After 12 months the overall score on the fall calendar and the Euroqol 5-D showed no significant differences between experimental and control group. The costs of the intervention amounted 382 Euros per person. Total healthcare costs as well as total patient and family costs did not differ significantly between the groups. Bootstrap analysis, confirmed that there are no differences in effects or costs between the groups. Incremental costs based on healthcare utilization during one year and effects on falls and quality of life are presented. Although the program did not lead to higher healthcare costs, we cannot recommend implementing the multidisciplinary intervention program in its present form, because the elderly participants did not benefit significantly from the intervention.
Source: SSRN Electronic Journal
Institution: Maastricht University
Language: English
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2344074707