Cost-Effectiveness of a Group vs Individually Delivered Exercise Program in Community-Dwelling Persons Aged ≥70 Years

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2022
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Gottschalk, Sophie
König, Hans-Helmut
Nerz, Corinna
Becker, Clemens
Klenk, Jochen
Jansen, Carl-Philipp
Dams, Judith
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Journal of the American Medical Directors Association. Elsevier. 2022, 23(5), pp. 736-742.e6. ISSN 1525-8610. eISSN 1538-9375. Available under: doi: 10.1016/j.jamda.2021.08.041
Zusammenfassung

Objectives
Interventions aimed at reducing falls and physical inactivity could alleviate the economic burden attributable to these factors. The study aimed to analyze the cost-effectiveness of a group-delivered version of the Lifestyle-integrated Functional Exercise Program compared with an individually delivered program version.

Design
An economic evaluation conducted alongside the LiFE-is-LiFE randomized non-inferiority trial.

Interventions
Group and individually delivered version of a program consisting of strength and balance exercises integrated into everyday activities to prevent falls.

Setting and participants
309 community-dwelling older adults (aged ≥70 years) at risk of falling recruited around Heidelberg and Stuttgart (Germany).

Methods
Cost-effectiveness of the group program was assessed over 6 months using different effect measures [quality-adjusted life years (QALYs, EQ-5D-5L), physical activity (mean number of steps/day), and falls] and cost perspectives (societal and payer’s). Incremental cost-effectiveness ratios were determined, and cost-effectiveness acceptability curves were constructed.

Results
From a societal perspective, mean costs, the number of falls, and the number of steps/day were somewhat higher in the group program, whereas QALYs were almost identical between the 2 interventions. From the payer’s perspective, the incremental cost-effectiveness ratio for the group compared to the individual program were €56,733 per QALY and €4755 per fall prevented. Based on the cost-effectiveness acceptability curves, the cost-effectiveness of the group program had to be rated as uncertain for both effect measures and perspectives. In contrast, it demonstrated cost-effectiveness for increasing physical activity at willingness-to-pay values per additional 1000 steps/day of €1600 (societal perspective) or €600 (payer’s perspective).

Conclusions and Implications
Compared to the individual program, the group program might be cost-effective for increasing physical activity in older adults but was unlikely to be cost-effective with regard to QALY or for preventing falls. The cost-effectiveness should be evaluated long-term and compared to a regular care group.

Zusammenfassung in einer weiteren Sprache
Fachgebiet (DDC)
796 Sport
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Cost-effectiveness, economic evaluation, falls, physical activity, older adults
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ISO 690GOTTSCHALK, Sophie, Hans-Helmut KÖNIG, Michael SCHWENK, Corinna NERZ, Clemens BECKER, Jochen KLENK, Carl-Philipp JANSEN, Judith DAMS, 2022. Cost-Effectiveness of a Group vs Individually Delivered Exercise Program in Community-Dwelling Persons Aged ≥70 Years. In: Journal of the American Medical Directors Association. Elsevier. 2022, 23(5), pp. 736-742.e6. ISSN 1525-8610. eISSN 1538-9375. Available under: doi: 10.1016/j.jamda.2021.08.041
BibTex
@article{Gottschalk2022CostE-58316,
  year={2022},
  doi={10.1016/j.jamda.2021.08.041},
  title={Cost-Effectiveness of a Group vs Individually Delivered Exercise Program in Community-Dwelling Persons Aged ≥70 Years},
  number={5},
  volume={23},
  issn={1525-8610},
  journal={Journal of the American Medical Directors Association},
  pages={736--742.e6},
  author={Gottschalk, Sophie and König, Hans-Helmut and Schwenk, Michael and Nerz, Corinna and Becker, Clemens and Klenk, Jochen and Jansen, Carl-Philipp and Dams, Judith}
}
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    <dcterms:abstract xml:lang="eng">Objectives&lt;br /&gt;Interventions aimed at reducing falls and physical inactivity could alleviate the economic burden attributable to these factors. The study aimed to analyze the cost-effectiveness of a group-delivered version of the Lifestyle-integrated Functional Exercise Program compared with an individually delivered program version.&lt;br /&gt;&lt;br /&gt;Design&lt;br /&gt;An economic evaluation conducted alongside the LiFE-is-LiFE randomized non-inferiority trial.&lt;br /&gt;&lt;br /&gt;Interventions&lt;br /&gt;Group and individually delivered version of a program consisting of strength and balance exercises integrated into everyday activities to prevent falls.&lt;br /&gt;&lt;br /&gt;Setting and participants&lt;br /&gt;309 community-dwelling older adults (aged ≥70 years) at risk of falling recruited around Heidelberg and Stuttgart (Germany).&lt;br /&gt;&lt;br /&gt;Methods&lt;br /&gt;Cost-effectiveness of the group program was assessed over 6 months using different effect measures [quality-adjusted life years (QALYs, EQ-5D-5L), physical activity (mean number of steps/day), and falls] and cost perspectives (societal and payer’s). Incremental cost-effectiveness ratios were determined, and cost-effectiveness acceptability curves were constructed.&lt;br /&gt;&lt;br /&gt;Results&lt;br /&gt;From a societal perspective, mean costs, the number of falls, and the number of steps/day were somewhat higher in the group program, whereas QALYs were almost identical between the 2 interventions. From the payer’s perspective, the incremental cost-effectiveness ratio for the group compared to the individual program were €56,733 per QALY and €4755 per fall prevented. Based on the cost-effectiveness acceptability curves, the cost-effectiveness of the group program had to be rated as uncertain for both effect measures and perspectives. In contrast, it demonstrated cost-effectiveness for increasing physical activity at willingness-to-pay values per additional 1000 steps/day of €1600 (societal perspective) or €600 (payer’s perspective).&lt;br /&gt;&lt;br /&gt;Conclusions and Implications&lt;br /&gt;Compared to the individual program, the group program might be cost-effective for increasing physical activity in older adults but was unlikely to be cost-effective with regard to QALY or for preventing falls. The cost-effectiveness should be evaluated long-term and compared to a regular care group.</dcterms:abstract>
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