Economic evaluation of a falls prevention exercise program among people With Parkinson's disease.

OBJECTIVE: The aim of this study was to determine the cost-effectiveness of a 6-month minimally supervised exercise program for people with PD. METHODS: An economic analysis was conducted alongside a randomized, controlled trial in which 231 people age 40 years and over with PD were randomized into a usual care control group or an exercise group. Cost-effectiveness was estimated using incremental cost per fall prevented (using falls calendars) as the primary analysis and cost per extra person avoiding mobility deterioration (defined as an improvement or no change in the 12-point Short Physical Performance Battery Score between baseline and 6 month). A cost-utility analysis using the Short Form-6D was also performed. Uncertainty was represented using cost-effectiveness scatter plots and acceptability curves. Planned subgroup analyses for the low-disease-severity group were also undertaken. RESULTS: All results are reported in Australian dollars ($A). The average cost of the intervention was $A1,010 per participant. Incremental cost-effectiveness of the program relative to usual care was $A574 per fall prevented, $A9,570 per extra person avoiding mobility deterioration, and $A338,800 per quality-adjusted life year gained. The intervention had an 80% probability of being cost-effective, relative to the control, at a threshold of $A2,000 per fall prevented. Subgroup analyses for the low-disease-severity group indicate the program to be dominant, that is, less costly and more effective than usual care for all health outcomes. CONCLUSION: The exercise intervention appeared cost-effective with regard to fall prevention in the whole sample and cost saving in the low disease severity group, when compared with usual care.

Economic modelling of a public health programme for fall prevention.

BACKGROUND: despite evidence on what works in falls prevention, falls in older people remain an important public health problem. AIMS: the purpose of this study was to model the impact and cost-effectiveness of a public health falls prevention programme, from the perspective of the health funder. METHODS: a decision analytic Markov model compared the health benefits in quality-adjusted life years (QALYs) and costs of treatment and residential aged care with and without a population heath falls prevention programme. Different intervention costs, uptake levels and programme effectiveness were modelled in sensitivity analyses. Uncertainty was explored using univariate and probabilistic sensitivity analysis. RESULTS: widespread rollout of a public health fall prevention programme could result in an incremental cost-effectiveness ratio (ICER) of $A28,931 per QALY gained, assuming a programme cost of $700 per person and at a fall prevention risk ratio of 0.75. This ICER would be considered cost-effective at a threshold value of $A50,000 per QALY gained. Sensitivity analyses for programme cost and effectiveness indicated that the public health programme produced greater health outcomes and was less costly than no programme when programme costs were $A500 or lower and risk ratio for falls was 0.70 or lower. At a cost of $A2,500, the public health falls prevention programme ceases to be a cost-effective option. CONCLUSION: serious consideration should be given to implementation of a public health programme of falls prevention as a cost-effective option that enables population-wide access to the intervention strategies.

A systematic review of the unit costs of allied health and community services used by older people in Australia.

BACKGROUND: An economic evaluation of interventions for older people requires accurate assessment of costing and consideration of both acute and long-term services. Accurate information on the unit cost of allied health and community services is not readily available in Australia however. This systematic review therefore aims to synthesise information available in the literature on the unit costs of allied health and community services that may be utilised by an older person living in Australia. METHOD: A comprehensive search of Medline, Embase, CINAHL, Google Scholar and Google was undertaken. Specialised economic databases were also reviewed. In addition Australian Government Department websites were inspected. The search identified the cost of specified allied health services including: physiotherapy, occupational therapy, dietetics, podiatry, counselling and home nursing. The range of community services included: personal care, meals on wheels, transport costs and domestic services. Where the information was not available, direct contact with service providers was made. RESULTS: The number of eligible studies included in the qualitative synthesis was fourty-nine. Calculated hourly rates for Australian allied health services were adjusted to be in equivalent currency and were as follows as follows: physiotherapy $157.75, occupational therapy $150.77, dietetics $163.11, psychological services $165.77, community nursing $105.76 and podiatry $129.72. CONCLUSIONS: Utilisation of the Medicare Benefits Scheduled fee as a broad indicator of the costs of services, may lead to underestimation of the real costs of services and therefore to inaccuracies in economic evaluation.

Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization.

BACKGROUND: Older people who have been recently discharged from hospital are at increased risk of falls and deterioration in physical functioning. OBJECTIVE: To investigate the cost-effectiveness of a 12-month home-exercise program for older adults after hospitalization. METHOD: An economic evaluation was conducted alongside a randomized controlled trial. The analysis was conducted from the health and community service provider perspective. A total of 340 people aged 60 years and older, with a recent hospital admission, were randomized into exercise and usual care control groups. Incremental costs per extra person showing improvement in mobility performance (using the Short Physical Performance Battery), per person indicating improvement in health (self-reported using a 3-point Likert scale) and per quality-adjusted life year (QALY) gained (utility measured using the EQ-5D) were estimated. Uncertainty was represented using cost-effectiveness acceptability curves. Subgroup analyses for participants with better cognition (above the median MMSE score of 28) also were undertaken. RESULTS: The average cost of the intervention was $A751 per participant. The incremental cost-effectiveness of the program relative to usual care was $A22,958 per extra person showing an improvement in mobility, $A19,020 per extra person indicating an improvement in health, and $A77,403 per QALY. The acceptability curve demonstrates that the intervention had an 80% probability of being cost-effective relative to the control at a threshold of $A48,000 per extra person achieving mobility improvement and $A36,000 indicating an improvement in self-reported health. There was no threshold value at which the program can be considered as having an 80% probability of cost-effectiveness for the QALY outcome. Subgroup analyses for participants with better cognitive status indicated improved cost-effectiveness for all outcomes. CONCLUSION: The exercise intervention appeared to offer reasonable value for money for mobility outcomes and self-reported health status. Value for money for all measures was greater in the higher cognitive status subgroup.