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

J Am Geriatr Soc. 2020 Sep;68(9):1988-1997. doi: 10.1111/jgs.16476. Epub 2020 May 29.

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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged, 80 and over
  • Canada
  • Cost-Benefit Analysis*
  • Exercise / physiology*
  • Female
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Independent Living*
  • Male
  • Neuropsychological Tests / statistics & numerical data
  • Outcome Assessment, Health Care
  • Quality-Adjusted Life Years
  • Secondary Prevention*
  • Surveys and Questionnaires

Associated data

  • ClinicalTrials.gov/NCT01029171
  • ClinicalTrials.gov/NCT00323596