Economic evaluation of the e-Health StandingTall balance exercise programme for fall prevention in people aged 70 years and over

Author:

Ambrens Meghan12ORCID,van Schooten Kimberley S23,Lung Thomas456,Clemson Lindy567,Close Jacqueline C T2,Howard Kirsten89109,Lord Stephen R23,Zijlstra G A Rixt1112,Tiedemann Anne8913,Valenzuela Trinidad141516,Vandelanotte Corneel17,Chow Jessica2,McInerney Garth2,Miles Lillian2,Woodbury Ashley2,Delbaere Kim23

Affiliation:

1. School of Health, Medicine and Applied Science, Appleton Institute, CQUniversity , Melbourne, VIC, Australia

2. Falls, Balance and Injury Research Centre, Neuroscience Research Australia , Randwick, NSW, Australia

3. School of Population Health, University of New South Wales , Sydney, NSW, Australia

4. The George Institute for Global Health, University of New South Wales , Newtown, NSW, Australia

5. Sydney School of Health Sciences , Faculty of Medicine and Health, , Sydney, NSW, Australia

6. The University of Sydney , Faculty of Medicine and Health, , Sydney, NSW, Australia

7. Centre for Excellence in Population Ageing Research, The University of Sydney , Sydney, NSW, Australia

8. School of Public Health , Faculty of Medicine and Health, , Sydney, Australia

9. The University of Sydney , Faculty of Medicine and Health, , Sydney, Australia

10. Menzies Centre for Health Policy and Economics , Faculty of Medicine and Health, , Sydney, Australia

11. Care and Public Health Research Institute , Department of Health Services Research, , Maastricht, The Netherlands

12. Maastricht University , Department of Health Services Research, , Maastricht, The Netherlands

13. Institute for Musculoskeletal Health, The University of Sydney , Sydney, NSW, Australia

14. Physical Activity , Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Medicine and Health Sciences, , Sydney NSW 2141, Australia

15. The University of Sydney , Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Medicine and Health Sciences, , Sydney NSW 2141, Australia

16. Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae , Santiago, Chile

17. Appleton Institute, CQUniversity , Rockhampton, QLD, Australia

Abstract

Abstract Background globally, falls and fall-related injuries are the leading cause of injury-related morbidity and mortality in older people. In our ageing society healthcare costs are increasing, therefore programmes that reduce falls and are considered value for money are needed. Objective to complete an economic evaluation of an e-Health balance exercise programme that reduced falls and injurious falls in community-dwelling older people compared to usual care from a health and community-care funder perspective. Design a within-trial economic evaluation of an assessor-blinded randomised controlled trial with 2 years of follow-up. Setting StandingTall was delivered via tablet-computer at home to older community-dwelling people in Sydney, Australia. Participants five hundred and three individuals aged 70+ years who were independent in activities of daily living, without cognitive impairment, progressive neurological disease or any other unstable or acute medical condition precluding exercise. Main outcome measures cost-effectiveness was measured as the incremental cost per fall and per injurious fall prevented. Cost-utility was measured as the incremental cost per quality-adjusted life year (QALY) gained. Main results the total average cost per patient for programme delivery and care resource cost was $8,321 (standard deviation [SD] 18,958) for intervention participants and $6,829 (SD 15,019) for control participants. The incremental cost per fall prevented was $4,785 and per injurious fall prevented was $6,585. The incremental cost per QALY gained was $58,039 (EQ5D-5L) and $110,698 (AQoL-6D). Conclusion this evaluation found that StandingTall has the potential to be cost-effective in specific subpopulations of older people, but not necessarily the whole older population. Trial registration ACTRN12615000138583.

Funder

Australian National Health and Medical Research Council

University of Sydney Robinson Fellowship

National Heart Foundation Postdoctoral Fellowship

NHMRC Early Career Fellowship

Human Frontier Science Program Fellowship

NeuRA Foundation

Gandel Philanthropy

Publisher

Oxford University Press (OUP)

Subject

Geriatrics and Gerontology,Aging,General Medicine

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