Division of Human Nutrition and Health, Wageningen University and Research, the Netherlands.
Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, the Netherlands; GGD Noord- en Oost-Gelderland, Academic Collaborative Center AGORA, Zutphen, the Netherlands.
J Am Med Dir Assoc. 2021 Apr;22(4):792-802.e2. doi: 10.1016/j.jamda.2020.12.036. Epub 2021 Feb 3.
Ageing is associated with a decline in functioning and a loss of independence, which will lead to increased health care costs in the future. The ProMuscle in Practice intervention was found to be effective in improving muscle strength, muscle mass, and functioning of older adults. The current study assesses the cost-effectiveness and perceived benefits of the intervention.
Trial-based cost-effectiveness analysis complemented by interviews.
A total of 168 community-dwelling older adults were included. Intervention participants started with a 12-week intensive support program, comprising resistance exercise guided by physiotherapists and consultations with a dietitian to increase protein intake. To maintain the adapted lifestyle pattern, they continued with a 12-week moderate support intervention. The control group received usual care.
Costs and outcomes were measured at baseline, after 12 and 24 weeks. Costs were assessed from a societal perspective. Health care use, out-of-pocket costs, and productivity losses were measured using questionnaires. Intervention costs were quantified according to bottom-up micro-costing. Outcomes included quality of life (EQ-5D-5L) and physical functioning (Short Physical Performance Battery [SPPB]). Bootstrap analyses were used to generate cost-effectiveness planes and acceptability curves. Interviews with participants and professionals were conducted after 24 weeks to measure perceived benefits.
An Incremental Cost-Effectiveness Ratio of €2988 ($3385)/point increase in SPPB was found. The intervention has an 82.4% probability of being cost-effective at a willingness to pay (WTP) of €12.000 ($13.559)/point increase in SPPB. No change in quality of life was found according to EQ-5D-5L. Interviews, however, revealed a wide range of function-related perceived benefits.
At a WTP of €12.000 ($13.559)/point increase in SPPB, the intervention was found to have an 82.4% probability of being cost-effective. Because generic quality of life questionnaires seem unable to detect subtle changes in public health interventions, future studies are advised to include targeted and specific questionnaires.
衰老与功能下降和独立性丧失有关，这将导致未来医疗保健成本增加。ProMuscle 在实践中的干预措施被发现能有效提高老年人的肌肉力量、肌肉质量和功能。本研究评估了干预措施的成本效益和感知收益。
基于试验的成本效益分析，辅以访谈。
共纳入 168 名社区居住的老年人。干预组参与者首先参加了为期 12 周的强化支持计划，包括由物理治疗师指导的阻力运动和与营养师咨询以增加蛋白质摄入。为了保持适应的生活方式模式，他们继续参加为期 12 周的适度支持干预。对照组接受常规护理。
在基线、12 周和 24 周时测量成本和结果。从社会角度评估成本。使用问卷测量医疗保健使用、自付费用和生产力损失。根据自下而上的微观成本核算量化干预成本。结果包括生活质量（EQ-5D-5L）和身体功能（简短身体表现电池 [SPPB]）。使用 Bootstrap 分析生成成本效益图和可接受性曲线。在 24 周后对参与者和专业人员进行访谈，以衡量感知收益。
发现 SPPB 每增加 1 分的增量成本效益比为 2988 欧元（3385 美元）。在愿意支付 12000 欧元（13559 美元）/SPPB 每增加 1 分时，干预措施有 82.4%的可能性具有成本效益。根据 EQ-5D-5L，生活质量没有变化。然而，访谈显示出广泛的与功能相关的感知收益。
在愿意支付 12000 欧元（13559 美元）/SPPB 每增加 1 分时，干预措施有 82.4%的可能性具有成本效益。由于通用生活质量问卷似乎无法检测到公共卫生干预措施的细微变化，因此建议未来的研究包括有针对性和特定的问卷。
