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COST-EFFECTIVENESS OF AN INTERVENTION TO REDUCE FEAR OF FALLING

Published online by Cambridge University Press:  19 June 2013

Jolanda C. M. van Haastregt ,
G.A. Rixt Zijlstra ,
Marike R. C. Hendriks ,
Mariëlle E.J.B. Goossens ,
Jacques Th.M. van Eijk  and
Gertrudis I.J.M. Kempen
Jolanda C. M. van Haastregt
Affiliation:
Maastricht University, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Department of Health Services Research
G.A. Rixt Zijlstra
Affiliation:
Maastricht University, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Department of Health Services Research
Marike R. C. Hendriks
Affiliation:
Maastricht University, Faculty of Health, Medicine and Life Sciences, School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Department of Human Movement Science
Mariëlle E.J.B. Goossens
Affiliation:
Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine
Jacques Th.M. van Eijk
Affiliation:
Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Social Medicine, Maastricht, the Netherlands
Gertrudis I.J.M. Kempen
Affiliation:
Maastricht University, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht, the Netherlands
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Abstract

Objectives: The aim of this study was to assess whether a multicomponent cognitive behavioral group intervention is preferable to usual care in terms of (healthcare) costs and effects on fear of falling and activity avoidance.

Methods: This economic evaluation was embedded in a randomized controlled trial among 540 community-living adults in the Netherlands, aged 70 years and older who reported fear of falling and fear-induced activity avoidance. The participants allocated to the intervention group received a multicomponent cognitive behavioral group intervention consisting of eight weekly sessions and a booster session. The sessions were aimed at instilling realistic views of falls, reducing fall risk, and increasing activity and safe behavior. Participants in the control group received usual care. Cost outcome measures were healthcare costs, and patient and family costs. Clinical outcomes were fear of falling and activity avoidance. All outcomes were assessed at baseline and at 2, 8, and 14 months by means of registration forms, self-administered questionnaires, and interviews by telephone.

Results: Participants were randomly allocated to intervention (n = 280) and control groups (n = 260). Costs for the intervention program were on average €276 per person. Total costs per person were comparable (€4,925 in intervention group and €4,828 in control group). Furthermore, favorable effects of the program were observed for fear of falling and activity avoidance.

Conclusions: This study showed that the intervention program is preferable to usual care in terms of costs and effects. The program had comparable costs and significantly reduced fear of falling and associated activity avoidance among older community-living persons.

Keywords

AgedRandomized controlled trialCost effectivenessAccidental fallsFear
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 3 , July 2013 , pp. 219 - 226
Copyright
Copyright © Cambridge University Press 2013 

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References

REFERENCES

1.Murphy, SL, Williams, CS, Gill, TM. Characteristics associated with fear of falling and activity restriction in community-living older persons. J Am Geriatr Soc. 2002;50:516–520.CrossRefGoogle ScholarPubMed
2.Zijlstra, GAR, van Haastregt, JCM, van Eijk, JThM, et al.Prevalence and correlates of fear of falling and avoidance of activity in a large random sample of older persons living in the community. Age Ageing. 2007;36:304–309CrossRefGoogle Scholar
3.Cumming, RG, Salkeld, G, Thomas, M, et al.Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. J Gerontol A Bio Sci Med Sci. 2000;55:M299–305.CrossRefGoogle ScholarPubMed
4.Howland, J, Peterson, EW, Levin, WC, et al.Fear of falling among the community-dwelling elderly. J Aging Health. 1993;5:229–243.CrossRefGoogle ScholarPubMed
5.Arfken, CL, Lach, HW, Birge, SJ, et al.The prevalence and correlates of fear of falling in elderly persons living in the community. Am J Public Health. 1994;84:565–570.CrossRefGoogle ScholarPubMed
6.Friedman, SM, Munoz, B, West, SK, et al.Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc. 2002;50:1329–1335.CrossRefGoogle Scholar
7.Meerding, WJ, Mulder, S, van Beeck, EF. Incidence and costs of injuries in the Netherlands. Eur J Public Health. 2006;16:272–278.CrossRefGoogle ScholarPubMed
8.Meerding, WJ, Bonneux, L, Polder, JJ, Koopmanschap, MA, van der Maas, PJ. Demographic and epidemiological determinants of healthcare costs in Netherlands: Cost of illness study. BMJ. 1998;317:111–115.CrossRefGoogle ScholarPubMed
9.Zijlstra, GAR, van Haastregt, JCM, van Rossum, E, et al.Interventions to reduce fear of falling in community-living older people: A systematic review. J Am Geriatr Soc. 2007;55:603–615.CrossRefGoogle ScholarPubMed
10.Tennstedt, S, Howland, J, Lachman, M, et al.A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. J Gerontol B Psychol Sci Soc Sci. 1994;53:P384–392.Google Scholar
11.Clemson, L, Cumming, RG, Kendig, H, et al.The effectiveness of a community-based program for reducing the incidence of falls in the elderly: A randomized trial. J Am Geriatr Soc. 2004;52:1487–1494.CrossRefGoogle ScholarPubMed
12.Zhang, JG, Ishikawa-Takata, K, Yamazaki, H, et al.The effects of tai chi chuan on physiological function and fear of falling in the less robust elderly: An intervention study for preventing falls. Arch Gerontol Geriatr. 2006;42:107–116.CrossRefGoogle ScholarPubMed
13.Zijlstra, GAR, van Haastregt, JCM, Ambergen, T, et al.Effects of a multicomponent cognitive behavioural group intervention on fear of falling and activity avoidance in community-dwelling older adults: Results of a randomized controlled trial. J Am Geriatr Soc. 2009;57:2020–2028.CrossRefGoogle ScholarPubMed
14.Zijlstra, GAR, Tennstedt, SL, van Haastregt, JCM, et al.Reducing fear of falling and avoidance of activity in elderly persons: The development of a Dutch version of an American intervention. Patient Educ Couns. 2006;62:220–227.CrossRefGoogle ScholarPubMed
15.Zijlstra, GAR.Managing concerns about falls. Fear of falling and avoidance of activity in older people. PhD thesis, Maastricht, 2007.Google Scholar
16.Zijlstra, GAR, van Haastregt, JCM, van Eijk, JThM, et al.Evaluating an intervention to reduce fear of falling and associated activity restriction in elderly persons: Design of a randomised controlled trial [ISRCTN43792817]. BMC Public Health. 2005;5:26.CrossRefGoogle ScholarPubMed
17.Delbaere, K, Crombez, G, Vanderstraeten, G, et al.Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age Ageing. 2004;33:368–373.CrossRefGoogle ScholarPubMed
18.Deshpande, N, Metter, EJ, Lauretani, F, et al.Activity restriction induced by fear of falling and objective and subjective measures of physical function: A prospective cohort study. J Am Geriatr Soc. 2008;56:615–620.CrossRefGoogle ScholarPubMed
19.van Haastregt, JCM, Zijlstra, GAR, van Rossum, E, et al.Feasibility of a cognitive behavioural Group intervention to reduce fear of falling and associated avoidance of activity in community living older people: A process-evaluation. BMC Health Serv Res. 2007;7:156.CrossRefGoogle ScholarPubMed
20.Oostenbrink, J, Bouwmans, C, Koopmanschap, M, et al. Handleiding voor kosten onderzoek; methoden en standaard kostprijzen voor economische evaluaties in de gezondehidszorg [Dutch manual for costing: Methods and standard costs for economic evaluations in healthcare]. Diemen: College voor Zorgverzekeringen; Geactualiseerde versie. 2004.Google Scholar
21.Oostenbrink, JB, Koopmanschap, MA, Rutten, FF. Standardisation of costs: The Dutch Manual for costing in economic evaluations. Pharmacoeconomics. 2002;20:443–454.CrossRefGoogle ScholarPubMed
22.Ramsey, S, Willke, R, Briggs, A, et al.Good research practices for cost-effectiveness analysis alongside clinical trials: The ISPOR RCT-CEA Task Force report. Value Health. 2005;8:521–533.CrossRefGoogle ScholarPubMed
23.Drummond, MF, Sculpher, MJ, Thorrance, GW, et al.Methods for the economic evaluation of health care programmes, 3rd ed.New York: Oxford University Press; 2005.CrossRefGoogle Scholar
24.Briggs, AH, Wonderling, DE, Mooney, CZ. Pulling cost-effectiveness analysis up by its bootstraps: A non-parametric approach to confidence interval estimation. Health Econ. 1997;6:327–340.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
25.Moore, DS, Ellis, R. Measurement of fall-related psychological constructs among independent-living older adults: A review of the research literature. Aging Mental Health 2008;12:684–699.CrossRefGoogle ScholarPubMed
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