对有复发性跌倒高风险的人进行多因素评估和治疗并不具有成本效益。
Multifactorial evaluation and treatment of persons with a high risk of recurrent falling was not cost-effective.
机构信息
Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
出版信息
Osteoporos Int. 2011 Jul;22(7):2187-96. doi: 10.1007/s00198-010-1438-4. Epub 2010 Oct 20.
SUMMARY
This study evaluated the cost-effectiveness of multifactorial evaluation and treatment of fall risk factors in community-dwelling older persons at high risk of falling. The intervention and usual care groups did not differ in fall risk or costs. The multifactorial approach was not cost-effective compared to usual care in this group.
INTRODUCTION
International guidelines recommend multifactorial evaluation and tailored treatment of risk factors to reduce falling in older persons. The cost-effectiveness may be enhanced in high-risk persons. Our study evaluates the cost-effectiveness of multifactorial evaluation and treatment of fall risk factors in community-dwelling older persons at high risk of recurrent falling.
METHODS
An economic evaluation was conducted alongside a randomised controlled trial. Participants (≥65 years) with a high risk of recurrent falling were randomised into an intervention (n = 106) and usual care group (n = 111). The intervention consisted of multifactorial assessment and treatment of fall risk factors. Clinical outcomes were proportions of fallers and utility during 1 year. Costs were measured using questionnaires at 3, 6 and 12 months after baseline and valued using cost prices, if available, and guideline prices. Differences in costs and cost-effectiveness were analysed using bootstrapping. Cost-effectiveness planes and acceptability curves were presented.
RESULTS
During 1 year, 52% and 56% of intervention and usual care participants reported at least one fall, respectively. The clinical outcome measures did not differ between the two groups. The mean costs were Euro 7,740 (SD 9,129) in the intervention group and Euro 6,838 (SD 8,623) in the usual care group (mean difference Euro 902, bootstrapped 95% CI: -1,534 to 3,357). Cost-effectiveness planes and acceptability curves indicated that multifactorial evaluation and treatment of fall risk factors was not cost-effective compared with usual care.
CONCLUSIONS
Multifactorial evaluation and treatment of persons with a high risk of recurrent falling was not cost-effective compared to usual care.
摘要
本研究评估了针对有高跌倒风险的社区居住老年人进行多因素评估和治疗跌倒风险因素的成本效益。干预组和常规护理组在跌倒风险或成本方面没有差异。与常规护理相比，多因素方法在该组中并不具有成本效益。
介绍
国际指南建议对老年人进行多因素评估和针对风险因素的个体化治疗，以降低跌倒风险。在高风险人群中，成本效益可能会提高。我们的研究评估了针对有高跌倒风险的社区居住老年人进行多因素评估和治疗跌倒风险因素的成本效益。
方法
一项经济评估是在一项随机对照试验的基础上进行的。参与者（≥65 岁）有高跌倒复发风险，被随机分为干预组（n=106）和常规护理组（n=111）。干预措施包括多因素评估和治疗跌倒风险因素。临床结局是 1 年内跌倒者的比例和效用。使用基线后 3、6 和 12 个月的问卷测量成本，并尽可能使用成本价格和指南价格进行评估。使用 bootstrap 分析成本和成本效益的差异。呈现成本效益平面和可接受性曲线。
结果
在 1 年内，干预组和常规护理组分别有 52%和 56%的参与者报告至少发生了一次跌倒。两组的临床结局测量值没有差异。干预组的平均成本为 7740 欧元（SD 9129 欧元），常规护理组的平均成本为 6838 欧元（SD 8623 欧元）（平均差异 902 欧元，bootstrap 95%CI：-1534 至 3357 欧元）。成本效益平面和可接受性曲线表明，与常规护理相比，多因素评估和治疗跌倒风险因素不具有成本效益。
结论
与常规护理相比，针对有高跌倒复发风险的人群进行多因素评估和治疗跌倒风险因素不具有成本效益。
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