Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
PLoS One. 2022 Apr 20;17(4):e0267247. doi: 10.1371/journal.pone.0267247. eCollection 2022.
Using stratified analyses, we examined the cost-effectiveness of the Otago Exercise Programme (OEP), from a health care system perspective, among older women and men who have previously fallen.
This study was a secondary stratified analysis (by women and men), of a 12-month prospective economic evaluation of a randomized clinical trial (OEP compared with usual care). Three hundred and forty four community-dwelling older adults (≥70; 172 OEP (110 women; 62 men), 172 usual care (119 women; 53 men)) who sustained a fall in the past 12 months and received a baseline assessment at the Vancouver Falls Prevention Clinic, Canada were included. A gender by OEP/usual care interaction was examined for the falls incidence rate ratio (IRR). Outcome measures stratified by gender included: falls IRR, incremental cost-per fall prevented (ICER), incremental cost per quality adjusted life year (QALY, ICUR) gained, and mean total health care resource utilization costs.
Men were frailer than women at baseline. Men incurred higher mean total healthcare costs $6794 (SD: $11906)). There was no significant gender by OEP/usual care interaction on falls IRR. The efficacy of the OEP did not vary by gender. The adjusted IRR for the OEP group demonstrated a 39% (IRR: 0.61, CI: 0.40-0.93) significant reduction in falls among men but not women (32% reduction (IRR: 0.69, CI: 0.47-1.02)). The ICER showed the OEP was effective in preventing falls and less costly for men, while it was costlier for women by $42. The ICUR showed the OEP did not impact quality of life.
Future studies should explore gender factors (i.e., health seeking behaviours, gender related frailty) that may explain observed variation in the cost-effectiveness of the OEP as a secondary falls prevention strategy.
ClinicalTrials.gov Protocol Registration System Identifier: NCT01029171; URL: https://clinicaltrials.gov/ct2/show/NCT01029171 Identifier: NCT00323596; URL: https://clinicaltrials.gov/ct2/show/NCT00323596.
我们通过分层分析，从医疗保健系统的角度，检查奥塔戈运动方案（OEP）在以前跌倒过的老年女性和男性中的成本效益。
这是一项 12 个月前瞻性经济评价的二次分层分析（按女性和男性分层），比较了随机临床试验（OEP 与常规护理）。344 名居住在社区的 70 岁以上老年人（172 名 OEP（110 名女性；62 名男性），172 名常规护理（119 名女性；53 名男性））在过去 12 个月内跌倒，并在加拿大温哥华跌倒预防诊所接受基线评估。检查了性别与 OEP/常规护理之间的交互作用，以确定跌倒发生率比（IRR）。按性别分层的结果包括：跌倒 IRR、每预防一次跌倒的增量成本（ICER）、每增加一个质量调整生命年（QALY，ICUR）的增量成本和平均总医疗保健资源利用成本。
男性在基线时比女性更脆弱。男性的平均总医疗保健费用更高，为 6794 美元（SD：11906 美元）。OEP/常规护理对跌倒 IRR 没有显著的性别交互作用。OEP 的疗效不因性别而异。OEP 组的调整后 IRR 显示男性跌倒风险降低 39%（IRR：0.61，CI：0.40-0.93），但女性无显著降低（降低 32%（IRR：0.69，CI：0.47-1.02））。ICER 显示 OEP 预防跌倒有效，且对男性来说成本更低，而对女性来说成本增加了 42 美元。ICUR 显示 OEP 对生活质量没有影响。
未来的研究应该探索性别因素（即健康寻求行为、与性别相关的脆弱性），这些因素可能解释了 OEP 作为二级跌倒预防策略的成本效益的变化。
ClinicalTrials.gov 方案注册系统标识符：NCT01029171；网址：https://clinicaltrials.gov/ct2/show/NCT01029171 标识符：NCT00323596；网址：https://clinicaltrials.gov/ct2/show/NCT00323596。
