Economic evaluation of the e-Health StandingTall balance exercise programme for fall prevention in people aged 70 years and over

Meghan Ambrens; Kimberley S van Schooten; Thomas Lung; Lindy Clemson; Jacqueline C T Close; Kirsten Howard; Stephen R Lord; G A Rixt Zijlstra; Anne Tiedemann; Trinidad Valenzuela; Corneel Vandelanotte; Jessica Chow; Garth McInerney; Lillian Miles; Ashley Woodbury; Kim Delbaere

doi:10.1093/ageing/afac130

Economic evaluation of the e-Health StandingTall balance exercise programme for fall prevention in people aged 70 years and over

Age Ageing. 2022 Jun 1;51(6):afac130. doi: 10.1093/ageing/afac130.

Authors

Meghan Ambrens^{1

2}, Kimberley S van Schooten^{2

3}, Thomas Lung^{4

5}, Lindy Clemson^{5

6}, Jacqueline C T Close², Kirsten Howard^{7

8}, Stephen R Lord^{2

3}, G A Rixt Zijlstra⁹, Anne Tiedemann^{7

10}, Trinidad Valenzuela^{11

12}, Corneel Vandelanotte¹³, Jessica Chow², Garth McInerney², Lillian Miles², Ashley Woodbury², Kim Delbaere^{2

3}

Affiliations

¹ School of Health, Medicine and Applied Science, Appleton Institute, CQUniversity, Melbourne, VIC, Australia.
² Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia.
³ School of Population Health, University of New South Wales, Sydney, NSW, Australia.
⁴ The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia.
⁵ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁶ Centre for Excellence in Population Ageing Research, The University of Sydney, Sydney, NSW, Australia.
⁷ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁸ Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁹ Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
¹⁰ Institute for Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia.
¹¹ Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney NSW 2141, Australia.
¹² Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile.
¹³ Appleton Institute, CQUniversity, Rockhampton, QLD, Australia.

PMID: 35679193
DOI: 10.1093/ageing/afac130

Abstract

Background: globally, falls and fall-related injuries are the leading cause of injury-related morbidity and mortality in older people. In our ageing society healthcare costs are increasing, therefore programmes that reduce falls and are considered value for money are needed.

Objective: to complete an economic evaluation of an e-Health balance exercise programme that reduced falls and injurious falls in community-dwelling older people compared to usual care from a health and community-care funder perspective.

Design: a within-trial economic evaluation of an assessor-blinded randomised controlled trial with 2 years of follow-up.

Setting: StandingTall was delivered via tablet-computer at home to older community-dwelling people in Sydney, Australia.

Participants: five hundred and three individuals aged 70+ years who were independent in activities of daily living, without cognitive impairment, progressive neurological disease or any other unstable or acute medical condition precluding exercise.

Main outcome measures: cost-effectiveness was measured as the incremental cost per fall and per injurious fall prevented. Cost-utility was measured as the incremental cost per quality-adjusted life year (QALY) gained.

Main results: the total average cost per patient for programme delivery and care resource cost was $8,321 (standard deviation [SD] 18,958) for intervention participants and $6,829 (SD 15,019) for control participants. The incremental cost per fall prevented was $4,785 and per injurious fall prevented was $6,585. The incremental cost per QALY gained was $58,039 (EQ5D-5L) and $110,698 (AQoL-6D).

Conclusion: this evaluation found that StandingTall has the potential to be cost-effective in specific subpopulations of older people, but not necessarily the whole older population.

Trial registration: ACTRN12615000138583.

Keywords: cost-effectiveness; home exercise; mHealth; older people; physical activity.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living*
Aged
Aged, 80 and over
Cost-Benefit Analysis
Exercise Therapy
Humans
Telemedicine*