@article{b38a05712a3e4923b768ba4bdf311c0f,
title = "Action Seniors! Cost-Effectiveness Analysis of a Secondary Falls Prevention Strategy Among Community-Dwelling Older Fallers",
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).",
keywords = "cost-effectiveness, cost-utility, economic evaluation, falls, older adults, Otago Exercise Program",
author = "Davis, {Jennifer C.} and Khan, {Karim M.} and Hsu, {Chun Liang} and Patrick Chan and Cook, {Wendy L.} and Larry Dian and Teresa Liu-Ambrose",
note = "Funding Information: This study is funded by the Canadian Institute for Health Research. T.L.A. is a Canada Research Chair in Physical Activity, Mobility, and Cognitive Neuroscience. K.M.K. holds a CIHR Scientific Director Research Grant. J.C.D. was funded by a CIHR and MSFHR Postdoctoral Fellowship for part of this trial. C.L.H. was funded by a CIHR Postdoctoral Award. Ethics was approved from the University of British Columbia's Clinical Ethics Review Board. The authors have no competing financial interests. T.L.A. is the Director of Research and Operations for the Vancouver Falls Prevention Clinic. J.C.D. is co-Director of Research and Operations for the Vancouver Falls Prevention Clinic. K.M.K. is Clinical Director for the Vancouver Falls Prevention Clinic. T.L.A. wrote the grant application that was funded by the Canadian Institute for Health Research and jointly drafted the Action Seniors! protocol. J.C.D. contributed to writing the grant application and wrote the health economics section that was funded by the Canadian Institute for Health Research and jointly drafted the Action Older Adults! protocol and primary article. C.L.H. and P.C. are part of the Action Seniors! research team and critically reviewed the manuscript. K.M.K. contributed to writing the grant application that was funded by the Canadian Institute for Health Research and critically reviewed the manuscript. L.D. and W.L.C. are the geriatricians at the Falls Prevention Clinic and part of the Action Seniors! research team. L.D. and W.L.C. critically reviewed the manuscript. The grant application formed the bases for the manuscript. All authors have read and approved the final manuscript. The funding agencies did not play a role in study design. Funding Information: This study is funded by the Canadian Institute for Health Research. T.L.A. is a Canada Research Chair in Physical Activity, Mobility, and Cognitive Neuroscience. K.M.K. holds a CIHR Scientific Director Research Grant. J.C.D. was funded by a CIHR and MSFHR Postdoctoral Fellowship for part of this trial. C.L.H. was funded by a CIHR Postdoctoral Award. Ethics was approved from the University of British Columbia's Clinical Ethics Review Board. Funding Information: T.L.A. wrote the grant application that was funded by the Canadian Institute for Health Research and jointly drafted the Action Seniors! protocol. J.C.D. contributed to writing the grant application and wrote the health economics section that was funded by the Canadian Institute for Health Research and jointly drafted the Action Older Adults! protocol and primary article. C.L.H. and P.C. are part of the Action Seniors! research team and critically reviewed the manuscript. K.M.K. contributed to writing the grant application that was funded by the Canadian Institute for Health Research and critically reviewed the manuscript. L.D. and W.L.C. are the geriatricians at the Falls Prevention Clinic and part of the Action Seniors! research team. L.D. and W.L.C. critically reviewed the manuscript. The grant application formed the bases for the manuscript. All authors have read and approved the final manuscript. Publisher Copyright: {\textcopyright} 2020 The American Geriatrics Society",
year = "2020",
month = sep,
day = "1",
doi = "10.1111/jgs.16476",
language = "English",
volume = "68",
pages = "1988--1997",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "9",
}