| Titre : | A Cost-Effectiveness Analysis of a Randomized Control Trial of a Tailored, Multifactorial Program to Prevent Falls Among the Community-Dwelling Elderly (2019) |
| Auteurs : | David B. Matchar ; Kirsten Eom ; Pamela W. Duncan |
| Type de document : | Article |
| Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 100, n° 1, 2019) |
| Article en page(s) : | p. 1-8 |
| Langues: | Anglais |
| Descripteurs : |
HE Vinci Rééducation et réadaptation |
| Mots-clés: | Costs and Cost Analysis ; Coûts et analyse des coûts ; Accidental Falls ; Chutes accidentelles ; Randomized controlled trial ; Essai contrôlé randomisé |
| Résumé : |
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. |
| Disponible en ligne : | Oui |
| En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999318311146 |
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