Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing

Scientific publication about the cost-effectiveness of a physical exercise program for healthy ageing

Authors: Tamara Alhambra-Borrás, Estrella Durá-Ferrandis and Maite Ferrando-García
Very recently a study was published in the International Journal of Environmental Research and Public Health using MAFEIP  to assess the cost-effectiveness of an intervention to improve healthy ageing. This study analyzed the effectiveness and cost-effectiveness of a group-based multicomponent physical exercise program. This program was aimed at reducing the risk of falling and frailty in community-dwelling older adults aged 65 years or older from the city of Valencia (Spain) with no severe physical or cognitive limitations. The authors conducted a pretest–posttest non-equivalent control group design, with an intervention group and a comparison group. Participants were evaluated at baseline and after 9 months. Inclusion criteria were having risk of falling and/or frailty and, for intervention group, acceptance to participate in the physical exercise program. Frailty was assessed using the Tilburg Frailty Index [TFI], and risk of falling was assessed using the following criteria recommended by American Geriatrics Society & British Geriatrics Society: 1) had fallen at least twice during the previous 12 months; 2) had self-reported walking problems; 3) had self-reported balance problems (criteria 2 and 3 were assessed using questions 3 and 4 of the TFI). Moreover, a forth criteria on having fear of falling was also included, as suggested in several studies.
The effectiveness analyses showed significant reduction in the risk of falling and frailty after the intervention for the participants in the physical exercise program. In particular, the risk of falling was reduced by 45.5% (p=.000) and frailty by 31% (p=.000) among intervention group participants. Moreover, these participants showed an improvement in limitations in activities of daily living, self-care ability and the use of health resources, physical performance, balance and body mass index. Finally, cost-effectiveness analyses of the intervention were conducted using the MAFEIP tool. On the one hand, incremental costs analysis referred to the difference between the cost that a person from a specific age and gender would have if he/she received the intervention minus the cost that would have if he/she followed usual care. The results of this analysis showed that incremental costs by age were negative meaning that, for older adults suffering from risk of falling and/or frailty, usual care was more expensive than the intervention. On the other hand, the incremental cost-effectiveness ratio (ICER) represented the overall impact of the physical exercise program on cost and quality-adjusted life years (QALYs) for the total target population. The position of the ICER in the lower-right quadrant indicated that the physical exercise program was cost-effective in comparison to the usual care alternative. Therefore, cost-effectiveness analyses conducted using MAFEIP showed that the intervention was cost-saving and more effective than usual care scenario.
In conclusion, a novel group-based multicomponent physical exercise program showed to be more effective and cost-effective than usual care for older adults suffering from risk of falling and frailty.
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