6 The cost-effectiveness of the Dutch In Balance fall prevention intervention | 111 Effect outcomes Table 6.2 presents the number of falls, fall-related injuries, and QALYs in the two groups and the unadjusted differences between groups. For all effect outcomes, the differences were in favor of the intervention group. However, none of the effect differences were statistically significant, except for the difference in QALYs based on the ASCOT. Table 6.2. The pooled mean effects, mean costs and differences per treatment group. Outcome In Balance (SE) Control (SE) Difference (95%CI) n = 131 n = 133 Costs in € Healthcare costs 5,002 (772) 7,771 (2197) -2,769 (-7221; 1,681) Primary care costs 833 (94) 1,037 (169) -204 (-566; 156) Secondary care costs 2,144 (573) 4,601 (2160) -2,457 (-6,658; 1744) Medication costs 1,097 (375) 1,067 (270) 30 (-872; 931) Home care costs 675 (121) 1,064 (299) -389 (-987; 208) Intervention costs 252 0 252 Informal care costs 430 (127) 623 (204) -193 (-655; 269) Lost productivity costs 737 (142) 1,869 (469) -1132 (-2,706; 442) Total societal costs 6,170 (830) 10,265 (2526) -4,095 (-9,239; 1,049) Effects Average number of falls 1.67 (0.24) 1.98 (0.37) -0.30 (-1.22; 0.62) Average number of fall- related injuries 0.70 (0.11) 0.97 (0.18) -0.27 (-0.68; 0.14) QALY (EQ-5D-5L) 0.82 (0.01) 0.78 (0.03) 0.04 (-0.02; 0.10) QALY (ASCOT)* 0.88 (0.01) 0.84 (0.02) 0.04 (0.003; 0.078) Notes. SE = Standard error, 95%CI = 95% Confidence interval, QALY = Quality adjusted life year, EQ-5D-5L = EuroQol questionnaire, ASCOT = Adult Social Care Outcome Toolkit questionnaire. Costs and effect differences are crude estimates. The intervention costs are estimated per person. Clinical effects are presented in the number of falls and injuries (not in prevented falls and prevented fall-related injuries). *Significantly different between groups. Cost-effectiveness analysis Table 6.3 presents cost-effectiveness results for falls, fall-related injuries, and QALYs from a societal perspective. The adjusted cost difference in total societal costs was €- 3,991 (95%CI: -8,993 to 1,011) between the intervention and the control groups. On average, the intervention was more effective and less expensive, i.e., dominant, over control for all four effect outcomes, although differences were not statistically significant. The In Balance intervention prevented on average 0.28 falls compared to the control (95% CI:-0.64 to 1.20). The ICER was €-14,329 per prevented fall with 70% of the bootstrapped cost-effect pairs in the southeast quadrant of the cost-effectiveness plane (more effective and less expensive) (Figure 6.2A). The probability of cost-effectiveness of the intervention compared to the control group was 98% at a WTP threshold of €0 per prevented fall and 91% at a WTP threshold of €10,000 per prevented fall (Figure 6.2B).
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