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Cost-effectiveness of a multicomponent training programme for older adults with decreased functional capacity: An
J Subías-Perié1, D Navarrete-Villanueva1, A I Fernández-García2
1EXER-GENUD (EXERCISE-Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, 50009, Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), University of Zaragoza, 50013, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009, Zaragoza, Spain; Department of Physiatry and Nursery, Faculty of Health Sciences, University of Zaragoza, 50009, Zaragoza, Spain; Exercise and Health in Special Population Spanish Research Net (EXERNET), University of Zaragoza, 50009, Zaragoza, Spain.
Purpose:
This study aimed to (I) examine the resources required to implement a multicomponent training (MCT) programme, (II) assess its impact on health care utilisation cost, and (III) evaluate its cost-effectiveness in older adults with decreased functional capacity.
Methods:
A total of 123 older adults (mean age: 80.3 ± 5.9 years) were allocated into a control (CON, n = 64) or training group (TRAIN, n = 59). The TRAIN group performed a 6-month MCT programme, which included aerobic exercise, resistance training, flexibility and balance components, while the CON group continued with their usual care. Functional capacity, frailty and health-related quality of life (HRQoL) were assessed at three different timepoints using the Short Physical Performance Battery (SPPB), Frailty Phenotype of Fried and the EuroQol-5D (EQ-5D), respectively. Primary outcome measures included the costs of delivering the MCT, health care utilisation, quality-adjusted life-years (QALYs), and the incremental cost effectiveness ratio (ICER). Analyses were conducted from a health system perspective with a 6-month time horizon.
Results:
While no significant changes were observed in the CON group, the TRAIN group showed improvements in SPPB (+3.38 ± 1.32), HRQoL (+0.07 ± 0.12), and frailty (-0.64 ± 1.06) (all p < 0.05). The average cost per TRAIN participant was €164. Health care utilisation cost was lower for TRAIN compared to CON (€3091 and €4135, respectively). The ICERs were €115/point increase in SPPB and €407/point reduction in frailty score. The cost per QALY gained by the TRAIN participant relative to the usual care cost was €6274. At a willingness-to-pay threshold of €49,000/QALY (Spanish Health System), the probability of the exercise intervention being cost-effective was 100 %.
Conclusions:
The 6-month Exernet-Elder 3.0 training programme demonstrated an ICER of €115 per SPPB point gained, €407 per point of frailty reduction, and €6274 per QALY gained. The intervention was low-cost (€164 per participant) and produced clinically meaningful improvements in functional capacity, HRQoL, and frailty. These findings underscore the importance of integrating a structured, group-based exercise programmes into public health strategies to address the growing socioeconomic and health burden associated with ageing populations.
Trial Registration:
ClinicalTrial.gov identifier: NCT03831841 DATE OF REGISTRATION: 6/02/2019 (Last update 02/07/2020).
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