title: Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization.
abstract: BACKGROUND
  Older people who have been recently discharged from hospital are at increased risk of falls and deterioration in physical functioning.
  
  
  OBJECTIVE
  To investigate the cost-effectiveness of a 12-month home-exercise program for older adults after hospitalization.
  
  
  METHODS
  An economic evaluation was conducted alongside a randomized controlled trial. The analysis was conducted from the health and community service provider perspective. A total of 340 people aged 60 years and older, with a recent hospital admission, were randomized into exercise and usual care control groups. Incremental costs per extra person showing improvement in mobility performance (using the Short Physical Performance Battery), per person indicating improvement in health (self-reported using a 3-point Likert scale) and per quality-adjusted life year (QALY) gained (utility measured using the EQ-5D) were estimated. Uncertainty was represented using cost-effectiveness acceptability curves. Subgroup analyses for participants with better cognition (above the median MMSE score of 28) also were undertaken.
  
  
  RESULTS
  The average cost of the intervention was $A751 per participant. The incremental cost-effectiveness of the program relative to usual care was $A22,958 per extra person showing an improvement in mobility, $A19,020 per extra person indicating an improvement in health, and $A77,403 per QALY. The acceptability curve demonstrates that the intervention had an 80% probability of being cost-effective relative to the control at a threshold of $A48,000 per extra person achieving mobility improvement and $A36,000 indicating an improvement in self-reported health. There was no threshold value at which the program can be considered as having an 80% probability of cost-effectiveness for the QALY outcome. Subgroup analyses for participants with better cognitive status indicated improved cost-effectiveness for all outcomes.
  
  
  CONCLUSIONS
  The exercise intervention appeared to offer reasonable value for money for mobility outcomes and self-reported health status. Value for money for all measures was greater in the higher cognitive status subgroup.
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia. Electronic address: ifarag@georgeinstitute.org.au.
authors.forename: Inez
authors.initials: I
authors.lastname: Farag
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Hayes
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Manuela L
authors.initials: ML
authors.lastname: Ferreira
authors.affiliation: Neuroscience Research Australia, UNSW, Randwick, NSW, Australia.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
authors.affiliation: Neuroscience Research Australia, UNSW, Randwick, NSW, Australia; Prince of Wales Clinical School, UNSW, Randwick, NSW, Australia.
authors.forename: Jacqueline T
authors.initials: JT
authors.lastname: Close
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Aged Care, Royal North Shore Hospital Reserve Road, St Leonard's, NSW, Australia.
authors.forename: Constance
authors.initials: C
authors.lastname: Vogler
authors.affiliation: Faculty of Human Sciences, Macquarie University, North Ryde, NSW, Australia.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Dean
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Cathie
authors.initials: C
authors.lastname: Sherrington
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics*; D005260:Female; D006699:Home Care Services / Q000191:economics*; D006760:Hospitalization; D006801:Humans; D008297:Male; D010351:Patient Discharge; D019057:Quality-Adjusted Life Years
keywords: Older people; exercise programs; fall prevention; hospitalization