PND9 - Cost-Effectiveness of the Pdsafe Home-Based Personalized Physiotherapy Intervention to Prevent Falls Among People with Parkinson’s: an Economic Evaluation Alongside a Randomised Controlled Trial

Abstract

PDSAFE is an individually-tailored, physiotherapist delivered balance, strength and strategy training programme aiming to prevent falls among people with Parkinson’s (PwP). The objective of this study was to evaluate the cost-effectiveness of PDSAFE compared with usual care for PwP who are at a higher risk of falling from a UK NHS and Personal Social Service (PSS) perspective. 238 PwP were randomised to the intervention group, receiving 12 physiotherapy sessions over 6-months; and 236 to the control group, receiving usual care (PDSAFE trial: ISRCTN48152791). Resource use and EQ-5D-3L data were collected at baseline, 3 months, 6 month, and 12 months. Missing data were imputed with multiple imputation. Generalized linear models were used to predict differences in costs and QALYs adjusting for baseline utility, baseline resource use, and the key demographics and medical history variables. A 1000-iteration Bootstrapping was conducted to investigate the uncertainty surrounding the Incremental cost effectiveness ratio (ICER) estimate. At six months, the intervention group is associated with an incremental cost of £925 (95%CI £429.0 to £1,432.9) and a 0.007 (95%CI -0.005 to 0.019) incremental QALY, leading to an ICER of £129,514 per QALY in base case analysis. The probability that the intervention was cost-effective at the £30,000 threshold was less than 1%. Although not cost-effective in the overall population, subgroup analyses indicated that the PDSAFE intervention appears likely to be cost-effective in the participants who were cognitively severely impaired (ICER=£8,438.6/QALY gained, probability to be cost effective=57.1%), and in the participants who had moderate severity of Parkinson’s (ICER=£16,663/QALY gained, probability=53.4%). PDSAFE is not likely to be cost-effective for the overall Parkinson’s population however the differential effects of PDSAFE on the resource use and utility gain in subgroups of PwP indicates the importance of stratified and personalized management and recommendations for PwP.