Costs of fall injuries in the STRIDE study: an economic evaluation of healthcare system heterogeneity and heterogeneity of treatment effect

Cost Effectiveness and Resource Allocation

Research

Shalender Bhasin¹  Nancy K. Latham¹  Thomas M. Gill²  David B. Reuben³  David A. Ganz⁴  Peter Peduzzi⁵  Erich J. Greene⁵ 

[1] Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA;Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA;RAND Corporation, Santa Monica, CA, USA;Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA;

关键词: Fall prevention;    Economic evaluation;    Heterogeneity of treatment effect;   

DOI  :  10.1186/s12962-023-00459-3

 received in 2023-01-07, accepted in 2023-07-21,  发布年份 2023

来源: Springer

【 摘 要 】

ObjectivesThe Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) Study cluster-randomized 86 primary care practices in 10 healthcare systems to a patient-centered multifactorial fall injury prevention intervention or enhanced usual care, enrolling 5451 participants. We estimated total healthcare costs from participant-reported fall injuries receiving medical attention (FIMA) that were averted by the STRIDE intervention and tested for healthcare-system-level heterogeneity and heterogeneity of treatment effect (HTE).MethodsParticipants were community-dwelling adults age ≥ 70 at increased fall injury risk. We estimated practice-level total costs per person-year of follow-up (PYF), assigning unit costs to FIMA with and without an overnight hospital stay. Using independent variables for treatment arm, healthcare system, and their interaction, we fit a generalized linear model with log link, log follow-up time offset, and Tweedie error distribution.ResultsUnadjusted total costs per PYF were $2,034 (intervention) and $2,289 (control). The adjusted (intervention minus control) cost difference per PYF was -$167 (95% confidence interval (CI), -$491, $216). Cost heterogeneity by healthcare system was present (p = 0.035), as well as HTE (p = 0.090). Adjusted total costs per PYF in control practices varied from $1,529 to $3,684 for individual healthcare systems; one system with mean intervention minus control costs of -$2092 (95% CI, -$3,686 to -$944) per PYF accounted for HTE, but not healthcare system cost heterogeneity.ConclusionsWe observed substantial heterogeneity of healthcare system costs in the STRIDE study, with small reductions in healthcare costs for FIMA in the STRIDE intervention accounted for by a single healthcare system.Trial registrationClinicaltrials.gov (NCT02475850).

【 授权许可】

CC BY   
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023

【 图 表 】

Fig. 4