OBJECTIVES:

To perform a cost-effectiveness analysis from a randomized controlled trial of a multifactorial, tailored intervention to reduce the occurrence of falls among a heterogeneous group of high-risk elderly Singaporeans recently discharged from the Emergency Department (ED).

METHODS: A tailored program of physical therapy focused on progressive training in strength, balance, and gait for a period of three months. The Short Physical Performance Battery (SPPB) test was assessed at regular intervals to allocate participants into either an individualized home-based or group centre-based program. Participants in the control group received usual care prescribed by a physician and educational materials on falls prevention.

The incremental cost-effectiveness ratio (ICER), based on a cost-effectiveness analysis from a health system’s perspective, taking into account program and healthcare utilization costs, and utility scores measured at baseline, three and nine months.

RESULTS:

The total cost per patient over a nine-month study period was S$ 3,718 for the intervention group and S$ 3,356 for the control group. The intervention group had an incremental gain of 0.003 per QALY compared to the control group leading to an ICER above benchmark values (S$120,667). However, the intervention was economically-dominant among those without severe disability (high SPPB at baseline), cognitive impairment or frequent prior falls, and better vision, and cost-effective among those with 0-1 critical comorbidities.

CONCLUSIONS:

The intervention was, overall, not cost-effective, compared to usual care. However, the program was cost-effective among healthier subgroups, implying the program is cost-effective, or, even, potentially, cost-saving among individuals with sufficient reserve to benefit.