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Randomized Controlled Trial
. 2016 Nov 4;16(1):179.
doi: 10.1186/s12877-016-0354-7.

Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL) trial

Suzanne Polinder  1 , Nicole D A Boyé  2   3 , Francesco U S Mattace-Raso  2 , Nathalie Van der Velde  2 , Klaas A Hartholt  2   3 , Oscar J De Vries  4 , Paul Lips  4 , Tischa J M Van der Cammen  2 , Peter Patka  5 , Ed F Van Beeck  6 , Esther M M Van Lieshout  3 ; IMPROveFALL trial collaborators
Collaborators, Affiliations
Randomized Controlled Trial

Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL) trial

Suzanne Polinder et al. BMC Geriatr. .

Abstract

Background: The use of Fall-Risk-Increasing-Drugs (FRIDs) has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus 'care as usual' on health-related quality of life (HRQoL), costs, and cost-utility in community-dwelling older fallers.

Methods: In a prospective multicenter randomized controlled trial FRIDs assessment combined with FRIDs-withdrawal or modification was compared with 'care as usual' in older persons, who visited the emergency department after experiencing a fall. For the calculation of costs the direct medical costs (intramural and extramural) and indirect costs (travel costs) were collected for a 12 month period. HRQoL was measured at baseline and at 12 months follow-up using the EuroQol-5D and Short Form-12 version 2. The change in EuroQol-5D and Short Form-12 scores over 12 months follow-up within the control and intervention groups was compared using the Wilcoxon Signed Rank test for continuous variables and the McNemar test for dichotomous variables. The change in scores between the control and intervention groups were compared using a two-way analysis of variance.

Results: We included 612 older persons who visited an emergency department because of a fall. The mean cost of the FRIDs intervention was €120 per patient. The total fall-related healthcare costs (without the intervention costs) did not differ significantly between the intervention group and the control group (€2204 versus €2285). However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant. Furthermore, the control group had a greater decline in EuroQol-5D utility score during the 12-months follow-up than the intervention group (p = 0.02). The change in the Short Form-12 Physical Component Summary and Mental Component Summary scores did not differ significantly between the two groups.

Conclusions: Withdrawal of FRID's in older persons who visited an emergency department due to a fall, did not lead to reduction of total health-care costs. However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant in combination with less decline in HRQoL is an important result.

Trial registration: The trial is registered in the Netherlands Trial Register ( NTR1593 - October 1st 2008).

Keywords: Cost utility; Falls; Medication withdrawal; Older persons; Quality of life.

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Figures

Fig. 1
Fig. 1
Flowchart of study participants. *Of the participants who died during follow-up, most were included in the analyses, except for two in the control and one in the intervention group. **Nine and 23 participants in the control and intervention group declined or were unable to complete EQ-5D questionnaires after 12-months follow-up
Fig. 2
Fig. 2
Prevalence of problems on the five dimensions of the EQ-5D in the control and intervention groups at baseline and 12 months follow-up. Nine and 23 participants in the control and intervention group declined or were unable to complete EQ-5D questionnaires after 12-months follow-up. *p-values were measured with the McNemar test
See this image and copyright information in PMC

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