Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL) trial.

Suzanne Polinder,The Improvefall Trial Collaborators ,Francesco U S Mattace-Raso,Paul Lips,Esther M M Van Lieshout,Nathalie Van Der Velde,Ed F Van Beeck,Klaas A Hartholt,Nicole D A Boyé,Peter Patka,Tischa J M Van Der Cammen,Oscar J De Vries

doi:10.1186/s12877-016-0354-7

Suzanne Polinder, The Improvefall Trial Collaborators + Show 10 more

Open Access

https://doi.org/10.1186/s12877-016-0354-7

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Abstract

BackgroundThe use of Fall-Risk-Increasing-Drugs (FRIDs) has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus ‘care as usual’ on health-related quality of life (HRQoL), costs, and cost-utility in community-dwelling older fallers.MethodsIn a prospective multicenter randomized controlled trial FRIDs assessment combined with FRIDs-withdrawal or modification was compared with ‘care as usual’ in older persons, who visited the emergency department after experiencing a fall. For the calculation of costs the direct medical costs (intramural and extramural) and indirect costs (travel costs) were collected for a 12 month period. HRQoL was measured at baseline and at 12 months follow-up using the EuroQol-5D and Short Form-12 version 2. The change in EuroQol-5D and Short Form-12 scores over 12 months follow-up within the control and intervention groups was compared using the Wilcoxon Signed Rank test for continuous variables and the McNemar test for dichotomous variables. The change in scores between the control and intervention groups were compared using a two-way analysis of variance.ResultsWe included 612 older persons who visited an emergency department because of a fall. The mean cost of the FRIDs intervention was €120 per patient. The total fall-related healthcare costs (without the intervention costs) did not differ significantly between the intervention group and the control group (€2204 versus €2285). However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant. Furthermore, the control group had a greater decline in EuroQol-5D utility score during the 12-months follow-up than the intervention group (p = 0.02). The change in the Short Form-12 Physical Component Summary and Mental Component Summary scores did not differ significantly between the two groups.ConclusionsWithdrawal of FRID’s in older persons who visited an emergency department due to a fall, did not lead to reduction of total health-care costs. However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant in combination with less decline in HRQoL is an important result.Trial registrationThe trial is registered in the Netherlands Trial Register (NTR1593 – October 1st 2008).Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0354-7) contains supplementary material, which is available to authorized users.

Highlights

The use of Fall-Risk-Increasing-Drugs (FRIDs) has been associated with increased risk of falls and associated injuries
The present study investigated costs, the effect on health-related quality of life (HRQoL), and the cost-utility of a structured medication assessment including withdrawal of FRIDs versus ‘care as usual’ in community-dwelling older men and women, who visited the Emergency Department (ED) after experiencing a fall [38]
In total, 7081 ED visitors were screened for inclusion in the study, of which 3294 were not eligible, 1954 refused to participate, 279 persons died before contact, 938 patients were failed to contact within 2 months, and of 4 patients data was lost

Summary

Introduction

The use of Fall-Risk-Increasing-Drugs (FRIDs) has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus ‘care as usual’ on health-related quality of life (HRQoL), costs, and cost-utility in community-dwelling older fallers. Falls affect a large proportion of persons aged 65 years and older and are associated with high mortality and morbidity, leading to great personal suffering, represented in loss of quality of life and high costs [1,2,3,4,5]. In 2000, the fall-related medical costs in the population aged 65 years and older in the United States amounted to US$19 billion for nonfatal injuries and US$200 million for fatal injuries [8]. The overall cost per fall was US$10,540 (€7800), mainly caused by direct medical costs [10]

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