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Randomized Controlled Trial
. 2020 Sep;68(9):1988-1997.
doi: 10.1111/jgs.16476. Epub 2020 May 29.

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

Jennifer C Davis  1   2   3 , Karim M Khan  2   4 , Chun Liang Hsu  2   5   6 , Patrick Chan  2 , Wendy L Cook  2   7 , Larry Dian  2   7 , Teresa Liu-Ambrose  2   3   6
Affiliations
Randomized Controlled Trial

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

Jennifer C Davis et al. J Am Geriatr Soc. 2020 Sep.

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://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).

Trial registration: ClinicalTrials.gov NCT01029171 NCT00323596.

Keywords: Otago Exercise Program; cost-effectiveness; cost-utility; economic evaluation; falls; older adults.

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References

REFERENCES

    1. Prevention of Falls and Injuries in the Elderly. Victoria, BC, Canada: Office of the Provincial Health Officer; 2003. https://www.health.gov.bc.ca/library/publications/year/2004/falls.pdf.
    1. Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018;66(4):693-698. https://doi.org/10.1111/jgs.15304.
    1. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009;2:CD007146.
    1. Robertson MC, Devlin N, Gardner MM, Campbell AJ. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls, 1: randomised controlled trial. BMJ. 2001;322(7288):697-701.
    1. Robertson MC, Devlin N, Scuffham P, Gardner MM, Buchner DM, Campbell AJ. Economic evaluation of a community based exercise programme to prevent falls. J Epidemiol Community Health. 2001;55(8):600-606.

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