Assessing the cost-effectiveness of conventional group based exercise and Tai Chi as interventions to reduce the risk of fall-related injuries in older people

Abstract

Objective: Our objective was determine whether there is an economic case for investment in group exercise programmes or Tai Chi compared with recommended multi-factorial programmes as protective interventions against the risk fall-related injury in older people in a UK context. Methods: A decision analytic model was built to compare costs and effects of conventional group exercise, Tai Chi and multi-factorial interventions for individuals aged 65+. A literature review identified parameters in the model, including risk of falling and sustaining injury, quality of life, costs of interventions, health service use and institutionalisation risk. The economic analysis was conducted from a health and social care perspective, using 2008 UK pounds. The main outcome was incremental cost per quality-adjusted life-year (QALY) gained. To explore uncertainty sensitivity analyses were run varying effectiveness, cost and utility gains associated with the interventions. Results: Participation in Tai Chi classes was shown to dominate investment in multi-factorial fall prevention strategies and conventional group exercise with both lower expected costs (£1087 vs £1190 or £1255 per participant) coupled with a small increase in quality of life. Our results remained robust in sensitivity analysis. In the worst case scenario the cost per QALY gained using Tai Chi was £14,899, a value considered highly cost effective in the UK health care system. Conclusions: Falls are a major cause of health and social care service utilisation. The risks of injury are particularly high in older people, at a cost in the UK alone to health and social services of £1 billion per annum. Currently the recommended approach for high risk individuals in guidelines issued by the English Department of Health and NICE is the use of multi-factorial interventions. The most recent Cochrane review suggests however that single intervention exercise based interventions including Tai Chi are likely to be more effective. Our economic analysis suggests that Tai Chi is potentially the most cost effective alternative to a multi-factorial intervention strategy for the prevention of falls in community dwelling older people. While Tai Chi may not be suitable for all older people, the QALY benefits shown are conservative: we did not take additional psychological benefits from reduced fear of falling, or the benefits of group activities in countering social isolation into account