[Economic evaluation of disability prevention programs for community-dwelling elderly secular trend analyses of medical and care expenses comparing participants and non-participants in the programs].

ABSTRACT

OBJECTIVE: This study was conducted to evaluate disability prevention programs for community-dwelling elderly in terms of the cost/benefit balance. METHODS: Out of all residents aged 65 years and over who lived in Yoita Town, Niigata Prefecture, Japan (n = 1,673), 1,544 persons participated in the baseline survey conducted in November, 2000 (response rate, 92.2%). Based on the results, Yoita town then launched several kinds of disability prevention programs for community-dwelling elderly, e.g., preventive programs for falls, dementia and homeboundness. The subjects for the present study included only those aged 70 years and over who responded to the baseline survey and were alive as of March 2004. During 2001 to 2003, 146 persons had participated at lease once in one of disability prevention programs (denoted as the participant group), whereas 846 persons had not participated in any of the programs (denoted as the non-participant group). We compared medical and care expenses (sum of national and employment health insurance benefits, and long-term care insurance) between the two groups during 2000-2003, and determined whether participating in program affected subsequent medical and care expenses independent of key confounders [sex, age, and baseline medical and care expenses or health indicator (TMIG-Index of Competence or Generic Mobility Index)], using general linear models. RESULTS: The mean medical expenses per capita and per month slightly decreased over the period of the study in the participant group (51,606 yen for 2000 to 47,539 yen for 2003), while those in non-participant group steadily increased (41,888 yen, to 51,558 yen, respectively). During the same period, the mean care cost per capita and per month increased in both groups, but the increase was much more moderate in the participating group (507 yen to 5,186 yen vs. 8,127 yen to 27,072 yen for non-participant group). Summed cost reduction through the program participation accounted for 49 million yen during the three years (2001-2003). After adjustment for sex, age and baseline medical and care expenses or health indicator, it was estimated as 12 million yen per year. Given that the expenses for the disability prevention programs summed 2.3 million yen per year, the net benefit of disability prevention programs was estimated to be approx. 10 million yen per year. CONCLUSION: Disability preventive programs for the community-dwelling elderly are economically efficient in terms of the cost/benefit balance. Future research is needed to examine how such programs lead to cost reduction.