Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany.
Department of Sport Science, Human Performance Research Centre, University of Konstanz, Constance, Germany.
BMC Geriatr. 2024 Feb 23;24(1):186. doi: 10.1186/s12877-024-04802-y.
Fall prevention is important for healthy ageing, but the economic impact of fall prevention are scarcely investigated. A recent cost-effectiveness analysis compared a group-delivered Lifestyle-integrated Functional Exercise Program (gLiFE) with an individually-delivered program (LiFE) in community-dwelling people (aged ≥ 70 years) at risk of falling. In addition, the current study aimed to analyze the budget impact of LiFE and gLiFE, compared with standard care in Germany.
A Markov model was developed to reflect falls and associated care needs for community-dwelling persons over 5 years. The intervention effects of LiFE and gLiFE were shown to be equivalent in a non-inferiority trial, although the costs differed. Outpatient, inpatient, and intervention costs were assessed from a payer's perspective. The effect of parameter uncertainty was assessed in sensitivity analyses.
The budget impact due to intervention costs was €510 million for LiFE and €186 million for gLiFE. Over five years, health care expenditures were €35,008 million for those receiving standard care, €35,416 million for those receiving LiFE, and €35,091 million for persons receiving gLiFE. Thereby, LiFE and gLiFE could prevent 2700 deaths and 648,000 falls over 5 years. Parameter uncertainties in the risk of falling, uptake of an intervention offer, and in the intervention effects had a major influence; thus cost savings for LiFE and gLiFE compared with standard care could be achieved for individuals with a high risk of falling.
The results revealed that cost savings for LiFE and gLiFE compared with standard care could only be achieved for individuals at high risk of falling, with gLiFE being superior to LiFE. Future research should consider benefits and aspects of fall prevention beyond falls (e.g., physical activity, social aspects, and personal preferences of participants).
The study was preregistered under underclinicaltrials.gov (identifier: NCT03462654) on 12th March 2018; https://clinicaltrials.gov/ct2/show/NCT03462654 .
预防跌倒对于健康老龄化很重要，但预防跌倒的经济影响却鲜有研究。最近的一项成本效益分析比较了小组式生活方式综合功能锻炼方案（gLiFE）和个体式锻炼方案（LiFE）在有跌倒风险的社区居住人群（年龄≥70 岁）中的效果。此外，本研究旨在分析德国 gLiFE 和 LiFE 与标准护理相比的预算影响。
采用 Markov 模型反映 5 年内社区居住者的跌倒及相关护理需求。非劣效性试验表明，LiFE 和 gLiFE 的干预效果相当，尽管成本不同。从支付者的角度评估了门诊、住院和干预成本。敏感性分析评估了参数不确定性的影响。
LiFE 的干预成本预算影响为 5.10 亿欧元，gLiFE 的干预成本预算影响为 1.86 亿欧元。五年内，接受标准护理的人群的医疗保健支出为 350.08 亿欧元，接受 LiFE 治疗的人群为 354.16 亿欧元，接受 gLiFE 治疗的人群为 350.91 亿欧元。因此，LiFE 和 gLiFE 可预防 5 年内 2700 例死亡和 648000 例跌倒。跌倒风险、干预措施提供的接受率和干预效果的参数不确定性有重大影响；因此，LiFE 和 gLiFE 与标准护理相比，可以为高跌倒风险人群节省成本。
结果表明，LiFE 和 gLiFE 与标准护理相比的成本节约仅可在高跌倒风险人群中实现，且 gLiFE 优于 LiFE。未来的研究应考虑跌倒预防的效益和方面，除了跌倒之外（例如身体活动、社会方面和参与者的个人喜好）。
该研究于 2018 年 3 月 12 日在 underclinicaltrials.gov（标识符：NCT03462654）进行了预先注册；https://clinicaltrials.gov/ct2/show/NCT03462654。
Zotero 插件
