Cost-effectiveness of a home-exercise program among older people after hospitalization

Inez Farag, Kirsten Howard, Alison J. Hayes, Manuela L. Ferreira, Stephen R. Lord, Jacqueline T. Close, Constance Vogler, Catherine M. Dean, Robert G. Cumming, Cathie Sherrington

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Older people who have been recently discharged from hospital are at increased risk of falls and deterioration in physical functioning. Objective: To investigate the cost-effectiveness of a 12-month home-exercise program for older adults after hospitalization. Method: An economic evaluation was conducted alongside a randomized controlled trial. The analysis was conducted from the health and community service provider perspective. A total of 340 people aged 60years and older, with a recent hospital admission, were randomized into exercise and usual care control groups. Incremental costs per extra person showing improvement in mobility performance (using the Short Physical Performance Battery), per person indicating improvement in health (self-reported using a 3-point Likert scale) and per quality-adjusted life year (QALY) gained (utility measured using the EQ-5D) were estimated. Uncertainty was represented using cost-effectiveness acceptability curves. Subgroup analyses for participants with better cognition (above the median MMSE score of 28) also were undertaken. Results: The average cost of the intervention was $A751 per participant. The incremental cost-effectiveness of the program relative to usual care was $A22,958 per extra person showing an improvement in mobility, $A19,020 per extra person indicating an improvement in health, and $A77,403 per QALY. The acceptability curve demonstrates that the intervention had an 80% probability of being cost-effective relative to the control at a threshold of $A48,000 per extra person achieving mobility improvement and $A36,000 indicating an improvement in self-reported health. There was no threshold value at which the program can be considered as having an 80% probability of cost-effectiveness for the QALY outcome. Subgroup analyses for participants with better cognitive status indicated improved cost-effectiveness for all outcomes. Conclusion: The exercise intervention appeared to offer reasonable value for money for mobility outcomes and self-reported health status. Value for money for all measures was greater in the higher cognitive status subgroup.

LanguageEnglish
Pages490-496
Number of pages7
JournalJournal of the American Medical Directors Association
Volume16
Issue number6
DOIs
Publication statusPublished - 1 Jun 2015

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Cost-Benefit Analysis
Hospitalization
Quality-Adjusted Life Years
N-ethylcarbaminomethyl-L-leucine
Costs and Cost Analysis
Health
Social Welfare
Cognition
Health Status
Uncertainty
Health Services
Randomized Controlled Trials
Control Groups

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Farag, I., Howard, K., Hayes, A. J., Ferreira, M. L., Lord, S. R., Close, J. T., ... Sherrington, C. (2015). Cost-effectiveness of a home-exercise program among older people after hospitalization. Journal of the American Medical Directors Association, 16(6), 490-496. https://doi.org/10.1016/j.jamda.2015.01.075
Farag, Inez ; Howard, Kirsten ; Hayes, Alison J. ; Ferreira, Manuela L. ; Lord, Stephen R. ; Close, Jacqueline T. ; Vogler, Constance ; Dean, Catherine M. ; Cumming, Robert G. ; Sherrington, Cathie. / Cost-effectiveness of a home-exercise program among older people after hospitalization. In: Journal of the American Medical Directors Association. 2015 ; Vol. 16, No. 6. pp. 490-496.
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abstract = "Background: Older people who have been recently discharged from hospital are at increased risk of falls and deterioration in physical functioning. Objective: To investigate the cost-effectiveness of a 12-month home-exercise program for older adults after hospitalization. Method: An economic evaluation was conducted alongside a randomized controlled trial. The analysis was conducted from the health and community service provider perspective. A total of 340 people aged 60years and older, with a recent hospital admission, were randomized into exercise and usual care control groups. Incremental costs per extra person showing improvement in mobility performance (using the Short Physical Performance Battery), per person indicating improvement in health (self-reported using a 3-point Likert scale) and per quality-adjusted life year (QALY) gained (utility measured using the EQ-5D) were estimated. Uncertainty was represented using cost-effectiveness acceptability curves. Subgroup analyses for participants with better cognition (above the median MMSE score of 28) also were undertaken. Results: The average cost of the intervention was $A751 per participant. The incremental cost-effectiveness of the program relative to usual care was $A22,958 per extra person showing an improvement in mobility, $A19,020 per extra person indicating an improvement in health, and $A77,403 per QALY. The acceptability curve demonstrates that the intervention had an 80{\%} probability of being cost-effective relative to the control at a threshold of $A48,000 per extra person achieving mobility improvement and $A36,000 indicating an improvement in self-reported health. There was no threshold value at which the program can be considered as having an 80{\%} probability of cost-effectiveness for the QALY outcome. Subgroup analyses for participants with better cognitive status indicated improved cost-effectiveness for all outcomes. Conclusion: The exercise intervention appeared to offer reasonable value for money for mobility outcomes and self-reported health status. Value for money for all measures was greater in the higher cognitive status subgroup.",
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Farag, I, Howard, K, Hayes, AJ, Ferreira, ML, Lord, SR, Close, JT, Vogler, C, Dean, CM, Cumming, RG & Sherrington, C 2015, 'Cost-effectiveness of a home-exercise program among older people after hospitalization', Journal of the American Medical Directors Association, vol. 16, no. 6, pp. 490-496. https://doi.org/10.1016/j.jamda.2015.01.075

Cost-effectiveness of a home-exercise program among older people after hospitalization. / Farag, Inez; Howard, Kirsten; Hayes, Alison J.; Ferreira, Manuela L.; Lord, Stephen R.; Close, Jacqueline T.; Vogler, Constance; Dean, Catherine M.; Cumming, Robert G.; Sherrington, Cathie.

In: Journal of the American Medical Directors Association, Vol. 16, No. 6, 01.06.2015, p. 490-496.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Cost-effectiveness of a home-exercise program among older people after hospitalization

AU - Farag, Inez

AU - Howard, Kirsten

AU - Hayes, Alison J.

AU - Ferreira, Manuela L.

AU - Lord, Stephen R.

AU - Close, Jacqueline T.

AU - Vogler, Constance

AU - Dean, Catherine M.

AU - Cumming, Robert G.

AU - Sherrington, Cathie

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Y1 - 2015/6/1

N2 - Background: Older people who have been recently discharged from hospital are at increased risk of falls and deterioration in physical functioning. Objective: To investigate the cost-effectiveness of a 12-month home-exercise program for older adults after hospitalization. Method: An economic evaluation was conducted alongside a randomized controlled trial. The analysis was conducted from the health and community service provider perspective. A total of 340 people aged 60years and older, with a recent hospital admission, were randomized into exercise and usual care control groups. Incremental costs per extra person showing improvement in mobility performance (using the Short Physical Performance Battery), per person indicating improvement in health (self-reported using a 3-point Likert scale) and per quality-adjusted life year (QALY) gained (utility measured using the EQ-5D) were estimated. Uncertainty was represented using cost-effectiveness acceptability curves. Subgroup analyses for participants with better cognition (above the median MMSE score of 28) also were undertaken. Results: The average cost of the intervention was $A751 per participant. The incremental cost-effectiveness of the program relative to usual care was $A22,958 per extra person showing an improvement in mobility, $A19,020 per extra person indicating an improvement in health, and $A77,403 per QALY. The acceptability curve demonstrates that the intervention had an 80% probability of being cost-effective relative to the control at a threshold of $A48,000 per extra person achieving mobility improvement and $A36,000 indicating an improvement in self-reported health. There was no threshold value at which the program can be considered as having an 80% probability of cost-effectiveness for the QALY outcome. Subgroup analyses for participants with better cognitive status indicated improved cost-effectiveness for all outcomes. Conclusion: The exercise intervention appeared to offer reasonable value for money for mobility outcomes and self-reported health status. Value for money for all measures was greater in the higher cognitive status subgroup.

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