Polinder Suzanne, Boyé Nicole D A, Mattace-Raso Francesco U S, Van der Velde Nathalie, Hartholt Klaas A, De Vries Oscar J, Lips Paul, Van der Cammen Tischa J M, Patka Peter, Van Beeck Ed F, Van Lieshout Esther M M
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
BMC Geriatr. 2016 Nov 4;16(1):179. doi: 10.1186/s12877-016-0354-7.
The use of Fall-Risk-Increasing-Drugs (FRIDs) has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus 'care as usual' on health-related quality of life (HRQoL), costs, and cost-utility in community-dwelling older fallers.
In a prospective multicenter randomized controlled trial FRIDs assessment combined with FRIDs-withdrawal or modification was compared with 'care as usual' in older persons, who visited the emergency department after experiencing a fall. For the calculation of costs the direct medical costs (intramural and extramural) and indirect costs (travel costs) were collected for a 12 month period. HRQoL was measured at baseline and at 12 months follow-up using the EuroQol-5D and Short Form-12 version 2. The change in EuroQol-5D and Short Form-12 scores over 12 months follow-up within the control and intervention groups was compared using the Wilcoxon Signed Rank test for continuous variables and the McNemar test for dichotomous variables. The change in scores between the control and intervention groups were compared using a two-way analysis of variance.
We included 612 older persons who visited an emergency department because of a fall. The mean cost of the FRIDs intervention was €120 per patient. The total fall-related healthcare costs (without the intervention costs) did not differ significantly between the intervention group and the control group (€2204 versus €2285). However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant. Furthermore, the control group had a greater decline in EuroQol-5D utility score during the 12-months follow-up than the intervention group (p = 0.02). The change in the Short Form-12 Physical Component Summary and Mental Component Summary scores did not differ significantly between the two groups.
Withdrawal of FRID's in older persons who visited an emergency department due to a fall, did not lead to reduction of total health-care costs. However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant in combination with less decline in HRQoL is an important result.
The trial is registered in the Netherlands Trial Register ( NTR1593 - October 1 2008).
使用增加跌倒风险的药物（FRIDs）与跌倒及相关损伤风险增加有关。本研究调查停用FRIDs与“常规护理”相比，对社区居住的老年跌倒者健康相关生活质量（HRQoL）、成本及成本效用的影响。
在一项前瞻性多中心随机对照试验中，将FRIDs评估并结合FRIDs停用或调整与“常规护理”进行比较，对象为跌倒后前往急诊科就诊的老年人。为计算成本，收集了12个月期间的直接医疗成本（机构内和机构外）和间接成本（交通成本）。使用欧洲五维健康量表（EuroQol-5D）和简明健康调查问卷（Short Form-12）第2版在基线和12个月随访时测量HRQoL。使用Wilcoxon符号秩检验比较连续变量在对照组和干预组12个月随访期间欧洲五维健康量表和简明健康调查问卷得分的变化，使用McNemar检验比较二分变量得分的变化。使用双向方差分析比较对照组和干预组得分的变化。
我们纳入了612名因跌倒前往急诊科就诊的老年人。FRIDs干预的平均成本为每位患者120欧元。干预组和对照组之间与跌倒相关的总医疗成本（不包括干预成本）无显著差异（2204欧元对2285欧元）。然而，停用FRIDs使每位参与者的药物成本平均降低38欧元。此外，在12个月随访期间，对照组欧洲五维健康量表效用得分的下降幅度大于干预组（p = 0.02）。两组之间简明健康调查问卷身体成分汇总得分和精神成分汇总得分的变化无显著差异。
因跌倒前往急诊科就诊的老年人停用FRIDs并未导致总医疗成本降低。然而，停用FRIDs使每位参与者的药物成本平均降低38欧元，同时HRQoL下降幅度较小，这是一个重要结果。
该试验已在荷兰试验注册库注册（NTR1593 - 2008年10月1日）。
