Economic evaluation of a home-based programme to reduce concerns about falls in frail, independently-living older people

Background: Concerns about falls, or fear of falling, are frequently reported by older people and can have serious consequences. Aim of this study was to evaluate the cost-effectiveness of a home-based, cognitive behavioral programme for independently-living, frail older people in comparison with usual care from a societal perspective.
Methods: This economic evaluation was embedded in a randomized-controlled trial with a follow-up of 12-months. In the trial 389 people aged 70 years or older were allocated to usual care (n = 195) or the intervention group (n = 194). The intervention group received a home-based, cognitive behavioral programme. Main outcome measures were concerns about falls and Quality Adjusted Life Years (QALYs).
Results: Average total costs per participant in the usual care group were 8,094 Euros and 7,890 Euros for participants in the intervention group. The intervention group showed a significant decrease in concerns about falls and a non-significant increase in QALYS in comparison with the usual care group. The probability that the intervention was cost-effective was 75% at a willingness to pay of 20,000 Euros per QALY.
Discussion: The programme is likely to be cost-effective, and therefore a useful addition to current geriatric care, particularly for those persons who are not able or willing to attend group programmes.
Trial registration: NCT01358032

背景：跌倒担忧或跌倒恐惧是老年人常见的健康问题，且可引发严重不良后果。本研究旨在从社会视角出发，对比居家认知行为干预方案与常规照护，评估前者对独立生活的衰弱老年人群的成本效益。
方法：本经济评价嵌入于一项随访时长为12个月的随机对照试验。该试验共纳入389名70岁及以上老年人，按分组方案分配至常规照护组（n=195）与干预组（n=194）。干预组接受居家认知行为干预方案。主要结局指标为跌倒担忧情况与质量调整寿命年（Quality Adjusted Life Years，QALYs）。
结果：常规照护组受试者的人均总费用为8094欧元，干预组为7890欧元。与常规照护组相比，干预组的跌倒担忧程度显著降低，而质量调整寿命年则呈非显著性升高。在每质量调整寿命年20000欧元的支付意愿阈值下，该干预方案具有成本效益的概率为75%。
讨论：本居家认知行为干预方案大概率具备成本效益，可作为当前老年照护体系的有益补充，尤其适用于无法或不愿参与集体照护项目的老年人群。
试验注册编号：NCT01358032