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Cost-effectiveness of preventive occupational therapy for independent-living older adults
Joel Hay1, Laurie LaBree, Roger Luo
1Department of Pharmaceutical Economics and Policy, School of Pharmacy, Keck School of Medicine, University of Southern California, Los Angeles 90033, USA.
Objectives:
To evaluate the cost-effectiveness of a 9-month preventive occupational therapy (OT) program in the Well-Elderly Study: a randomized trial in independent-living older adults that found significant health, function, and quality of life benefits attributable to preventive OT.
Design:
A randomized trial.
Setting:
Two government-subsidized apartment complexes.
Participants:
One hundred sixty-three culturally diverse volunteers aged 60 and older.
Intervention:
An OT group, a social activity group (active control), and a nontreatment group (passive control).
Measurements:
Use of healthcare services was determined by telephone interview during and after the treatment phase. A conversion algorithm was applied to the RAND 36-item Short Form Health Survey to derive a preference-based health-related quality of life index, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio for preventive OT relative to the combined control group.
Results:
Costs for the 9-month OT program averaged $548 per subject. Postintervention healthcare costs were lower for the OT group ($967) than for the active control group ($1,726), the passive control group ($3,334), or a combination of the control groups ($2,593). The quality of life index showed a 4.5% QALY differential (OT vs combined control), P <.001. The cost per QALY estimates for the OT group was $10,666 (95% confidence interval = $6,747-$25,430). For the passive and active control groups, the corresponding costs per QALY were $13,784 and $7,820, respectively.
Conclusion:
In this study, preventive OT demonstrated cost-effectiveness in conjunction with a trend toward decreased medical expenditures.