Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
J Am Geriatr Soc. 2010 Jan;58(1):136-41. doi: 10.1111/j.1532-5415.2009.02575.x.
To model the incremental cost-utility of seven interventions reported as effective for preventing falls in older adults.
Mathematical epidemiological model populated by data based on direct clinical experience and a critical review of the literature.
Model represents population level interventions.
No human subjects were involved in the study. MEASUREMENS: The last Cochrane database review and meta-analyses of randomized controlled trials categorized effective fall-prevention interventions into seven groups: medical management (withdrawal) of psychotropics, group tai chi, vitamin D supplementation, muscle and balance exercises, home modifications, multifactorial individualized programs for all elderly people, and multifactorial individualized treatments for high-risk frail elderly people. Fall-related hip fracture incidence was obtained from the literature. Salary figures for health professionals were based on Bureau of Labor Statistics data. Using an integrated healthcare system perspective, healthcare costs were estimated based on practice and studies on falls in older adults. Base case incremental cost utility ratios were calculated, and probabilistic sensitivity analyses were conducted.
Medical management of psychotropics and group tai chi were the least-costly, most-effective options, but they were also the least studied. Excluding these interventions, the least-expensive, most-effective options are vitamin D supplementation and home modifications. Vitamin D supplementation costs less than home modifications, but home modifications cost only $14,794/quality-adjusted life year (QALY) gained more than vitamin D. In probabilistic sensitivity analyses excluding management of psychotropics and tai chi, home modification is most likely to have the highest economic benefit when QALYs are valued at $50,000 or $100,000.
Of single interventions studied, management of psychotropics and tai chi reduces costs the most. Of more-studied interventions, home modifications provide the best value. These results must be interpreted in the context of the multifactorial nature of falls.
构建七种预防老年人跌倒干预措施的增量成本-效用模型，这些干预措施被报道为有效。
基于直接临床经验和文献综述的批判性评价，利用数据构建的数学流行病学模型。
代表人群水平干预的模型。
本研究未涉及人类受试者。
最近的 Cochrane 数据库综述和随机对照试验的荟萃分析将有效的跌倒预防干预措施分为七组：精神药物的医学管理（停药）、小组太极拳、维生素 D 补充、肌肉和平衡锻炼、家庭改造、所有老年人的多因素个体化计划以及高风险体弱老年人的多因素个体化治疗。跌倒相关髋部骨折的发生率来自文献。卫生专业人员的工资数据基于劳工统计局的数据。从综合医疗保健系统的角度出发，根据老年人跌倒的实践和研究，估算医疗保健成本。计算基本病例增量成本效用比，并进行概率敏感性分析。
精神药物的医学管理和小组太极拳是最具成本效益、最有效的选择，但它们的研究也最少。排除这些干预措施，最便宜、最有效的选择是维生素 D 补充和家庭改造。维生素 D 补充的成本低于家庭改造，但家庭改造的成本仅为 14794 美元/QALY（每增加一个质量调整生命年的成本），高于维生素 D。在排除精神药物管理和太极拳的概率敏感性分析中，当 QALY 价值为 50000 美元或 100000 美元时，家庭改造最有可能具有最高的经济效益。
在所研究的单一干预措施中，精神药物管理和太极拳的成本降低最多。在更多研究的干预措施中，家庭改造提供了最佳价值。这些结果必须在跌倒的多因素性质的背景下进行解释。
