Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom.
NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom.
Gerontology. 2018;64(5):503-512. doi: 10.1159/000489171. Epub 2018 Jun 26.
Falls are a major cause of morbidity among older people. Multifaceted interventions may be effective in preventing falls and related fractures.
To evaluate the cost-effectiveness alongside the REducing Falls with Orthoses and a Multifaceted podiatry intervention (REFORM) trial.
REFORM was a pragmatic multicentre cohort randomised controlled trial in England and Ireland; 1,010 participants (> 65 years) were randomised to receive either a podiatry intervention (n = 493), including foot and ankle strengthening exercises, foot orthoses, new footwear if required, and a falls prevention leaflet, or usual podiatry treatment plus a falls prevention leaflet (n = 517).
incidence of falls per participant in the 12 months following randomisation.
proportion of fallers and quality of life (EQ-5D-3L) which was converted into quality-adjusted life years (QALYs) for each participant. Differences in mean costs and QALYs at 12 months were used to assess the cost-effectiveness of the intervention relative to usual care. Cost-effectiveness analyses were conducted in accordance with National Institute for Health and Clinical Excellence reference case standards, using a regression-based approach with costs expressed in GBP (2015 price). The base case analysis used an intention-to-treat approach on the imputed data set using multiple imputation.
There was a small, non-statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73-1.05, p = 0.16). Participants allocated to the intervention group accumulated on average marginally higher QALYs than the usual care participants (mean difference 0.0129, 95% CI -0.0050 to 0.0314). The intervention costs were on average GBP 252 more per participant compared to the usual care participants (95% CI GBP -69 to GBP 589). Incremental cost-effectiveness ratios ranged between GBP 19,494 and GBP 20,593 per QALY gained, below the conventional National Health Service cost-effectiveness thresholds of GBP 20,000 to GBP 30,000 per additional QALY. The probability that the podiatry intervention is cost-effective at a threshold of GBP 30,000 per QALY gained was 0.65. The results were robust to sensitivity analyses.
The benefits of the intervention justified the moderate cost. The intervention could be a cost-effective option for falls prevention when compared with usual care in the UK.
跌倒是老年人发病的主要原因。多方面的干预措施可能对预防跌倒和相关骨折有效。
在英格兰和爱尔兰进行的减少矫形器和多方面足病学干预措施（REFORM）试验中，评估其成本效益。
REFORM 是一项实用的多中心队列随机对照试验；1010 名（>65 岁）参与者被随机分为接受足部干预组（n=493）或常规足部治疗组（n=517）。足部干预组接受足部和踝关节强化锻炼、足部矫形器、新鞋，如果需要，并提供预防跌倒的传单；常规足部治疗组加提供预防跌倒的传单。
随机分组后 12 个月内每位参与者的跌倒发生率。
跌倒者的比例和生活质量（EQ-5D-3L），将其转换为每位参与者的质量调整生命年（QALY）。在 12 个月时，比较干预组和常规护理组的平均成本和 QALY，以评估干预措施相对于常规护理的成本效益。根据国家卫生与临床优化研究所参考病例标准进行成本效益分析，使用基于回归的方法，以英镑（2015 年价格）表示成本。基于意向治疗的分析使用多重插补的概率模型在推断数据集上进行。
干预组跌倒发生率略有下降，但无统计学意义（调整后的发病率比为 0.88，95%CI 0.73-1.05，p=0.16）。与常规护理组相比，接受干预组的参与者平均获得的 QALY 略高（平均差异 0.0129，95%CI -0.0050 至 0.0314）。与常规护理组相比，干预组的平均每位参与者的成本高出 252 英镑（95%CI -69 至 589 英镑）。增量成本效益比在每获得一个 QALY 的 19494 英镑至 20593 英镑之间，低于英国国家医疗服务体系每增加一个 QALY 的 20000 英镑至 30000 英镑的常规成本效益阈值。在每获得一个 QALY 收益 30000 英镑的阈值下，足部干预措施具有成本效益的概率为 0.65。结果对敏感性分析具有稳健性。
干预措施的收益证明了其适度的成本是合理的。与常规护理相比，在英国，该干预措施可能是预防跌倒的一种具有成本效益的选择。
