A Cost-Effectiveness Model for Frail Older Persons: Development and Application to a Physiotherapy-Based Intervention

Area of Science:

• Gerontology
• Health Economics
• Public Health

Background:

• The clinical significance of frailty is growing, necessitating long-term economic evaluations of interventions.
• Existing economic studies on frailty management often have limited time horizons.
• This research addresses the need for lifetime cost and outcome predictions in frail populations.

Purpose of the Study:

• To develop a cost-effectiveness model for predicting lifetime costs and quality-adjusted life years (QALYs) in frail Australians.
• To conduct a model-based cost-utility analysis of a physiotherapy intervention for frail individuals.

Main Methods:

• A cohort-based state transition (Markov) model was created to predict lifetime costs and QALYs.
• The model incorporates health states for frailty, residential status, bone fractures, depression, and mortality.
• Input parameters were derived from the Dynamic Analyses to Optimise Ageing dataset and literature.

Main Results:

• The developed cost-effectiveness model underwent validation and proved reliable.
• A physiotherapy intervention for frailty yielded an incremental cost of Australian $8129 per QALY gained compared to usual care.
• There is a 30% probability that usual care is more cost-effective than the physiotherapy intervention.

Conclusions:

• Frailty significantly impacts quality of life and incurs substantial management costs, with increasing prevalence.
• New frailty management strategies must demonstrate economic value.
• The cost-effectiveness model provides a framework for evaluating interventions and informing funding decisions in Australia.