title: A Cost-Effectiveness Model for Frail Older Persons: Development and Application to a Physiotherapy-Based Intervention.
abstract: BACKGROUND
  The clinical importance of frailty is increasing. Existing economic evaluations of interventions to manage frailty have limited time horizons, but even in older populations there may be important longer-term differences in costs and outcomes. This paper reports on the development of a cost-effectiveness model to predict publicly funded health and aged care costs and quality-adjusted life years (QALYs) over the remaining lifetime of frail Australians and a model-based cost-utility analysis of a physiotherapy-based intervention for frail individuals.
  
  
  METHODS
  A cohort-based state transition (Markov) model was developed to predict costs and QALYs over the remaining lifetime of a frail population. Frailty is defined using the phenotypic definition of frailty, and the model comprises health states that describe frailty status, residential status, the experience of bone fractures and depression, and death. Model input parameters were estimated and calibrated using the Dynamic Analyses to Optimise Ageing dataset, supplemented with data from the published literature.
  
  
  RESULTS
  The cost-effectiveness model was subject to a range of validation approaches, which did not negate the validity of the model. The evaluated physiotherapy-based frailty intervention has an expected incremental cost per QALY gained of Australian $8129 compared to usual care, but there is a probability of 0.3 that usual care is more effective and less costly than the intervention.
  
  
  CONCLUSIONS
  Frailty reduces quality of life, is costly to manage and it's prevalence is increasing, but new approaches to managing frailty need to demonstrate value for money. The value of the reported cost-effectiveness model is illustrated through the estimation of all important costs and effects of a physiotherapy-based frailty intervention, which facilitates comparisons with funding decisions for other new technologies in Australia.
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA, 5005, Australia. jonathan.karnon@adelaide.edu.au.|Centre for Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, 5005, Australia. jonathan.karnon@adelaide.edu.au.
authors.forename: Jonathan
authors.identifier: http://orcid.org/0000-0003-3220-2099
authors.initials: J
authors.lastname: Karnon
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA, 5005, Australia.|Centre for Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, 5005, Australia.
authors.forename: Hossein Haji Ali
authors.initials: HHA
authors.lastname: Afzali
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA, 5005, Australia.
authors.forename: Gregorius Virgianto Arpuji Anggoro
authors.initials: GVAA
authors.lastname: Putro
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA, 5005, Australia.
authors.forename: Phyu Win
authors.initials: PW
authors.lastname: Thant
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA, 5005, Australia.
authors.forename: Ameline
authors.initials: A
authors.lastname: Dompok
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA, 5005, Australia.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Cox
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA, 5005, Australia.
authors.forename: Owen Henry
authors.initials: OH
authors.lastname: Chikhwaza
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA, 5005, Australia.
authors.forename: Xian
authors.initials: X
authors.lastname: Wang
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA, 5005, Australia.
authors.forename: Mercy Mukui
authors.initials: MM
authors.lastname: Mwangangi
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA, 5005, Australia.
authors.forename: Matahari
authors.initials: M
authors.lastname: Farransahat
authors.affiliation: Centre for Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, 5005, Australia.|Sydney Medical School, University of Sydney, Edward Ford Building (A27), Fisher Road, Sydney, NSW, 2006, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Cameron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D006233:Persons with Disabilities / Q000534:rehabilitation* / Q000706:statistics & numerical data; D005081:Exercise Therapy / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D018803:Models, Economic; D026741:Physical Therapy Modalities / Q000191:economics* / Q000706:statistics & numerical data*
keywords: Frailty Phenotype; Frailty Status; QALY Gain; Residential Aged Care; Residential Care