Economic evaluation of a home-based programme to reduce concerns about falls in frail, independently-living older people

Figures & data

Table 1. Baseline characteristics and outcomes (n = 289)

	Usual care group n = 159		Intervention group n = 130
AMB-home intervention
≥ 5 sessions (%)	NA		117 (90)
Demographic
Female (%)	117	(73.6)	84	(64.6)
Mean age in years (SD)	77.7	(5.2)	78.0	(5.4)
Living alone (%)	96	(60.4)	74	(56.9)
Low education level (%)	77	(48.4)	72	(55.4)
Health-related
Poor perceived general health (%)	14	(8.8)	15	(11.5)
Mean number of active chronic diseases (SD)	1.6	(0.9)	1.7	(0.9)
SF-6D classification index (<0-1) (SD)	0.65	(0.1)	0.65	(0.1)
Fall-related
Once or more falls in the past 6 months (%)	87	(54.7)	83	(63.9)
Regular till very often concerned to fall (%)	81	(50.9)	68	(52.3)
Regular till very often avoid activities (%)	73	(45.9)	69	(53.1)
FES-I (16–64) (SD)	35.1	(9.3)	35.1	(9.9)
FES-IAB (16–64) (SD)	28.6	(9.1)	28.0	(9.0)

*Underlined scores = most favorable scores.

Figure 1. Flow of participants through the trial

Table 2. Mean (SD) costs in euros of healthcare utilization after 12 months (n = 289)

	Usual care group (n = 159)					Intervention group (n = 130)					Bootstrap 95% Uncertainty interval
Care category	Mean	(SD)	Median	Min	Max	Mean	(SD)	Median	Min	Max	2.5^th percentile*	97.5^th percentile
Intervention costs  (Training, material and hours    facilitator)	0	(0)	0	0	0	716	(0)	716	716	716
Healthcare costs	2,884	(4,218)	1,603	0	40,439	2,936	(4,236)	1,751	0	30,164	−921	1092
Primary care
General practitioner (contacts)	344	(267)	293	0	1,689	309	(223)	280	0	1,320	−92	21
Consultation	188	(183)	145	0	1,479	189	(173)	145	0	1,305	−38	42
Telephone consultation	61	(69)	30	0	330	49	(60)	30	0	345	−26	2
Home visit	94	(189)	0	0	1,080	71	(120)	0	0	540	−58	13
Physiotherapy (contracts)	938	(1,378)	296	0	5,406	950	(1,149)	495	0	4,876	−295	274
Other therapists (contacts)	139	(421)	0	0	4,233	138	(394)	0	0	2,470	−98	93
Hospital care
Admission and day care (days)	996	(3,420)	0	0	34,352	1,080	(3,744)	0	0	25,312	−708	935
Medical specialists (contacts)	468	(435)	330	0	2,178	458	(472)	330	0	2904	−112	107
Patient and family costs	5,210	(4,962)	3,836	0	26,420	4,239	(4,068)	3,476	0	17,608	−1985	11
Professional home care (hours)	1,028	(2,726)	0	0	15,479	593	(1,767)	0	0	11,339	−924	75
Professional domestic help  (hours)	2,386	(2,715)	675	0	9100	2,095	(2,508)	0	0	7,800	−923	327
Domestic help (hours)	397	(856)	0	0	4,212	412	(808)	0	0	3,380	−178	213
Informal care (hours)	890	(2,153)	65	0	17,420	658	(1299)	65	0	7,020	−644	140
Home adaptations (number)	83	(236)	0	0	1,482	87	(200)	0	0	1,066	−48	55
Aids and assistive devices    (number)	425	(825)	24	0	4,285	394	(818)	24	0	4,182	−217	140
Total costs	8,094	(7,466)	5,779	363	58,445	7,890	(6,450)	6,211	794	36,387	−1890	1305

*Confidence interval of the difference in costs between both groups. Negative costs represent savings compared to the intervention group (i.e. costs in the control group are lower than costs in the intervention group.

Table 3. Cost-effectiveness analyzes and sensitivity analyzes for concerns about falls and QALY

				Distribution of cost-effectiveness plane
	Usual care Group (N)	Intervention Group (N)	ICER^a	NE^b %	NW^c % (inferior)	SW^d %	SE^e % (dominant)
Concerned about falls^f
Concerned about falls  base case	159	130	−59 (dominant)	40	0	0	60
Per-protocol	159	104	−204 (dominant)	18	0	0	82
Healthcare perspective	159	130	13	54	0	0	46
Without outliers	158	128	−61 (dominant)	33	0	0	67
Activity avoidance^h	159	130	−264 (dominant)	39	1	0	60
QALY^g
QALY base case	159	130	−9,586 (dominant)	38	3	1	57
Per-protocol	159	104	−159,846 (dominant)	17	4	6	74
Healthcare perspective	159	130	−14,018 (dominant)	51	4	1	44
Without outliers	158	128	−35,330 (dominant)	30	3	2	65

^aIncremental cost-effectiveness ratio

^bNorth East quadrant: the intervention was more effective and more costly as compared to usual care

^cSouth East quadrant: the intervention was more effective and less costly as compared to usual care

^dNorth West quadrant: the intervention was less effective and more costly as compared to usual care

^eSouth West quadrant: the intervention was less effective and less costly as compared to usual care

^fMeasured with the Falls Efficacy Scale-International

^gQuality adjusted life years measured with the SF-6D

^hMeasured with the Falls Efficacy Scale-Avoidance Behavior International

Figure 2. Cost-effectiveness planes (CE-planes) and incremental cost-effectiveness acceptability (ICEA) curves for concerns about falls (FES-I as outcome)

ICEA-curves for AMB-Home, with on the y-axis the probability that the program is cost-effective and on the x-axis the willingness to pay given various ceiling ratios with respect to concerns about falls. Sensitivity analyzes performed for per-protocol (B1& B2), healthcare perspective (C1 & C2), without outliers (D1 & D2), and activity avoidance (E1 & E2). Reps: ICER replication; Ll: lower limit of the 95% confidence interval; PE: mean ICER; Ul: upper limit of 95% confidence interval

Figure 3. Cost-utility planes (CU-planes) and incremental cost-effectiveness acceptability (ICEA) curves for QALYs

CE-planes for QALYs (SF-6D classification index as outcome) and ICEA-curves for AMB-Home, with on the y-axis the probability that the program is cost-effective and on the x-axis the willingness to pay given various ceiling ratios with respect to QALYs. Sensitivity analyzes performed for per-protocol (B1& B2), healthcare perspective (C1 & C2), without outliers (D1 & D2). Reps: ICER replication; Ll: lower limit of the 95% confidence interval; PE: mean ICER; Ul: upper limit of 95% confidence interval.

Data Availability Statement

Facilitator and participants’ manuals, as well as data and the statistical code are available on request from the corresponding author at [email protected].