title: Cost-effectiveness of preventive occupational therapy for independent-living older adults.
abstract: 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.
authors.affiliation: Department of Pharmaceutical Economics and Policy, School of Pharmacy, Keck School of Medicine, University of Southern California, Los Angeles 90033, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Hay
authors.forename: Laurie
authors.initials: L
authors.lastname: LaBree
authors.forename: Roger
authors.initials: R
authors.lastname: Luo
authors.forename: Florence
authors.initials: F
authors.lastname: Clark
authors.forename: Mike
authors.initials: M
authors.lastname: Carlson
authors.forename: Deborah
authors.initials: D
authors.lastname: Mandel
authors.forename: Ruth
authors.initials: R
authors.lastname: Zemke
authors.forename: Jeanne
authors.initials: J
authors.lastname: Jackson
authors.forename: Stanley P
authors.initials: SP
authors.lastname: Azen
mesh_terms: 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