Rizzo J A, Baker D I, McAvay G, Tinetti M E
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA.
Med Care. 1996 Sep;34(9):954-69. doi: 10.1097/00005650-199609000-00007.
Falls and fall injuries are common-potentially preventable-causes of morbidity, functional decline, and increased health-care use among elderly persons. The current analyses, performed on data obtained as part of a randomized controlled trial conducted within a health maintenance organization, describe the costs of a multifactorial, targeted prevention program for falls, present total net health-care costs, estimate the cost per fall prevented, and describe acute fall-related health-care costs.
The 301 participants were at least 70 years of age and possessed at least one of eight targeted risk factors for falling. The 153 participants randomized to the targeted intervention (TI) group received a combination of medication adjustment, behavioral recommendations, and exercises as determined by their baseline assessment. The 148 participants randomized to the usual care (UC) group received a series of home visits by a social work student.
The mean intervention cost per TI participant was $925 (range $588 to $1,346). Total mean health-care costs were approximately $2,000 less in the TI than UC group, whereas median costs were approximately $1,100 higher in the TI than UC group. The TI strategy was unequivocally cost effective when mean costs were used because the intervention was associated with both lowered total health-care costs and fewer total and medical care falls. In sensitivity analyses, the cost-effectiveness of the TI strategy appeared robust to widely differing assumptions about total health-care costs (25th to 75th percentile of the actual distribution) and intervention costs (minimum to maximum costs). In subgroup analyses, the TI strategy showed its strongest effect among individuals at high risk of falling, defined as possession of at least four of the eight targeted risk factors.
Consideration should be given toward incorporating and reimbursing the cost of fall-prevention programs within the usual health care of community-living elderly persons, particularly for those persons at high risk for falling.
跌倒及跌倒损伤是老年人发病、功能衰退及医疗保健使用增加的常见且可能可预防的原因。本次分析使用了作为健康维护组织内一项随机对照试验的一部分所获取的数据，描述了针对跌倒的多因素、有针对性预防计划的成本，呈现了总的净医疗保健成本，估算了预防每例跌倒的成本，并描述了与跌倒相关的急性医疗保健成本。
301名参与者年龄至少70岁，且拥有八个有针对性的跌倒风险因素中的至少一个。随机分配到有针对性干预（TI）组的153名参与者根据其基线评估接受了药物调整、行为建议和锻炼的组合。随机分配到常规护理（UC）组的148名参与者接受了一名社会工作专业学生的一系列家访。
每名TI参与者的平均干预成本为925美元（范围为588美元至1346美元）。TI组的总平均医疗保健成本比UC组约低2000美元，而中位数成本TI组比UC组约高1100美元。当使用平均成本时，TI策略显然具有成本效益，因为该干预与降低的总医疗保健成本以及更少的总跌倒和医疗护理跌倒相关。在敏感性分析中，TI策略的成本效益对于关于总医疗保健成本（实际分布的第25至75百分位数）和干预成本（最低至最高成本）的广泛不同假设似乎是稳健的。在亚组分析中，TI策略在跌倒高风险个体（定义为拥有八个有针对性风险因素中的至少四个）中显示出最强的效果。
应考虑在社区居住老年人的常规医疗保健中纳入并报销跌倒预防计划的成本，特别是对于那些跌倒高风险人群。
