Cost-effectiveness of preventive occupational therapy for independent-living older adults.
OBJECTIVE
To evaluate the cost-effectiveness of a 9-month preventive occupational therapy (OT) program in the Well-Elderly Study: a randomized trial in independent-living older adults that found significant health, function, and quality of life benefits attributable to preventive OT.


METHODS
A randomized trial.


METHODS
Two government-subsidized apartment complexes.


METHODS
One hundred sixty-three culturally diverse volunteers aged 60 and older.


METHODS
An OT group, a social activity group (active control), and a nontreatment group (passive control).


METHODS
Use of healthcare services was determined by telephone interview during and after the treatment phase. A conversion algorithm was applied to the RAND 36-item Short Form Health Survey to derive a preference-based health-related quality of life index, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio for preventive OT relative to the combined control group.


RESULTS
Costs for the 9-month OT program averaged $548 per subject. Postintervention healthcare costs were lower for the OT group ($967) than for the active control group ($1,726), the passive control group ($3,334), or a combination of the control groups ($2,593). The quality of life index showed a 4.5% QALY differential (OT vs combined control), P <.001. The cost per QALY estimates for the OT group was $10,666 (95% confidence interval = $6,747-$25,430). For the passive and active control groups, the corresponding costs per QALY were $13,784 and $7,820, respectively.


CONCLUSIONS
In this study, preventive OT demonstrated cost-effectiveness in conjunction with a trend toward decreased medical expenditures.
Hay
Joel
J
Department of Pharmaceutical Economics and Policy, School of Pharmacy, Keck School of Medicine, University of Southern California, Los Angeles 90033, USA.
LaBree
Laurie
L
Luo
Roger
R
Clark
Florence
F
Carlson
Mike
M
Mandel
Deborah
D
Zemke
Ruth
R
Jackson
Jeanne
J
Azen
Stanley P
SP
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006299:Health Services for the Aged / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000191:economics*; D011314:Preventive Health Services / Q000191:economics*; D015397:Program Evaluation; D011788:Quality of Life; D019057:Quality-Adjusted Life Years