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Cost-effectiveness of the PDSAFE personalised physiotherapy intervention for fall prevention in Parkinson’s: an economic evaluation alongside a randomised controlled trial

Cost-effectiveness of the PDSAFE personalised physiotherapy intervention for fall prevention in Parkinson’s: an economic evaluation alongside a randomised controlled trial
Cost-effectiveness of the PDSAFE personalised physiotherapy intervention for fall prevention in Parkinson’s: an economic evaluation alongside a randomised controlled trial

Background: PDSAFE is an individually-tailored, physiotherapist-delivered, balance, strength and strategy training programme aimed at preventing falls among people with Parkinson's. We evaluated the cost-effectiveness of PDSAFE compared with usual care for people with Parkinson's at higher risk of falling, from a UK National Health Service and Personal Social Service perspective. Methods: Resource use and quality of life data (EQ-5D-3L) were collected from 238 participants randomised to the PDSAFE intervention and 236 participants randomised to control, at baseline, 3 months, 6 months (primary outcome), and 12 months. Adjusted cost and quality-adjusted life-years (QALYs) were estimated using generalised linear models and uncertainty estimated using a non-parametric bootstrap. Results: Over 6 months, the PDSAFE intervention was associated with an incremental cost of £925 (95% CI £428 to £1422) and a very small and statistically insignificant QALY gain of 0.008 (95% CI - 0.006 to 0.021). The resulting incremental cost-effectiveness ratio (ICER) was £120,659 per QALY and the probability of the intervention being cost-effective at a UK threshold of £30,000/QALY was less than 1%. The ICER varied substantially across subgroups although no subgroup had an ICER lower than the £30,000 threshold. The result was sensitive to the time horizon with the ICER reducing to £55,176 per QALY when adopting a 12-month time horizon and assuming a sustained treatment effect on QoL, nevertheless, the intervention was still not cost-effective according to the current UK threshold. Conclusions: Evidence from this trial suggests that the PDSAFE intervention is unlikely to be cost-effective at 6 months. The 12-month analysis suggested that the intervention became closer to being cost-effective if quality of life effects were sustained beyond the intervention period, however this would require confirmation. Further research, including qualitative studies, should be conducted to better understand the treatment effect of physiotherapy and its impact on quality of life in people with Parkinson's given existing mixed evidence on this topic. Trial registration: ISRCTN48152791. Registered 17 April 2014. http://www.isrctn.com/ISRCTN48152791.

Cost, Cost-effectiveness, Parkinson's, Physiotherapist, Quality of life
1471-2377
1-9
Xin, Yiqiao
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Ashburn, Ann
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Pickering, Ruth M.
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Seymour, Kim Chivers
de44472b-fe30-4e69-8d86-9ca6cf45074d
Hulbert, Sophia
eaded0e0-3abe-4972-8138-526baac5c472
Fitton, Carolyn
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Kunkel, Dorit
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Marian, Ioana
8aa4401c-8be4-455e-bdba-902f2fc78e84
Roberts, Helen C.
5ea688b1-ef7a-4173-9da0-26290e18f253
Lamb, Sarah E.
10720635-b8c7-4450-9f1f-22509fed6db8
Goodwin, Victoria A.
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Rochester, Lynn
ab1451e1-569c-43cd-ad84-987befff3f16
Mcintosh, Emma
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Xin, Yiqiao
61a0aef2-8262-4623-ad1c-39a33a6659d3
Ashburn, Ann
818b9ce8-f025-429e-9532-43ee4fd5f991
Pickering, Ruth M.
4a828314-7ddf-4f96-abed-3407017d4c90
Seymour, Kim Chivers
de44472b-fe30-4e69-8d86-9ca6cf45074d
Hulbert, Sophia
eaded0e0-3abe-4972-8138-526baac5c472
Fitton, Carolyn
6288734e-9b6e-470d-b420-33c16d65b879
Kunkel, Dorit
6b6c65d5-1d03-4a13-9db8-1342cd43f352
Marian, Ioana
8aa4401c-8be4-455e-bdba-902f2fc78e84
Roberts, Helen C.
5ea688b1-ef7a-4173-9da0-26290e18f253
Lamb, Sarah E.
10720635-b8c7-4450-9f1f-22509fed6db8
Goodwin, Victoria A.
b0c94379-0aaf-4ca2-a64d-1501954ffe7f
Rochester, Lynn
ab1451e1-569c-43cd-ad84-987befff3f16
Mcintosh, Emma
2f26b70d-5d8a-429c-a2c0-e2a98a6c0196

Xin, Yiqiao, Ashburn, Ann, Pickering, Ruth M., Seymour, Kim Chivers, Hulbert, Sophia, Fitton, Carolyn, Kunkel, Dorit, Marian, Ioana, Roberts, Helen C., Lamb, Sarah E., Goodwin, Victoria A., Rochester, Lynn and Mcintosh, Emma (2020) Cost-effectiveness of the PDSAFE personalised physiotherapy intervention for fall prevention in Parkinson’s: an economic evaluation alongside a randomised controlled trial. BMC Neurology, 20 (1), 1-9, [295]. (doi:10.1186/s12883-020-01852-8).

Record type: Article

Abstract

Background: PDSAFE is an individually-tailored, physiotherapist-delivered, balance, strength and strategy training programme aimed at preventing falls among people with Parkinson's. We evaluated the cost-effectiveness of PDSAFE compared with usual care for people with Parkinson's at higher risk of falling, from a UK National Health Service and Personal Social Service perspective. Methods: Resource use and quality of life data (EQ-5D-3L) were collected from 238 participants randomised to the PDSAFE intervention and 236 participants randomised to control, at baseline, 3 months, 6 months (primary outcome), and 12 months. Adjusted cost and quality-adjusted life-years (QALYs) were estimated using generalised linear models and uncertainty estimated using a non-parametric bootstrap. Results: Over 6 months, the PDSAFE intervention was associated with an incremental cost of £925 (95% CI £428 to £1422) and a very small and statistically insignificant QALY gain of 0.008 (95% CI - 0.006 to 0.021). The resulting incremental cost-effectiveness ratio (ICER) was £120,659 per QALY and the probability of the intervention being cost-effective at a UK threshold of £30,000/QALY was less than 1%. The ICER varied substantially across subgroups although no subgroup had an ICER lower than the £30,000 threshold. The result was sensitive to the time horizon with the ICER reducing to £55,176 per QALY when adopting a 12-month time horizon and assuming a sustained treatment effect on QoL, nevertheless, the intervention was still not cost-effective according to the current UK threshold. Conclusions: Evidence from this trial suggests that the PDSAFE intervention is unlikely to be cost-effective at 6 months. The 12-month analysis suggested that the intervention became closer to being cost-effective if quality of life effects were sustained beyond the intervention period, however this would require confirmation. Further research, including qualitative studies, should be conducted to better understand the treatment effect of physiotherapy and its impact on quality of life in people with Parkinson's given existing mixed evidence on this topic. Trial registration: ISRCTN48152791. Registered 17 April 2014. http://www.isrctn.com/ISRCTN48152791.

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Accepted/In Press date: 1 July 2020
e-pub ahead of print date: 11 August 2020
Keywords: Cost, Cost-effectiveness, Parkinson's, Physiotherapist, Quality of life

Identifiers

Local EPrints ID: 445543
URI: http://eprints.soton.ac.uk/id/eprint/445543
ISSN: 1471-2377
PURE UUID: 1ccca5c8-4e1e-4d18-a5ba-2951d7d6c648
ORCID for Dorit Kunkel: ORCID iD orcid.org/0000-0003-4449-1414
ORCID for Helen C. Roberts: ORCID iD orcid.org/0000-0002-5291-1880

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Date deposited: 15 Dec 2020 17:31
Last modified: 28 Apr 2022 01:51

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Contributors

Author: Yiqiao Xin
Author: Ann Ashburn
Author: Kim Chivers Seymour
Author: Sophia Hulbert
Author: Carolyn Fitton
Author: Dorit Kunkel ORCID iD
Author: Ioana Marian
Author: Sarah E. Lamb
Author: Victoria A. Goodwin
Author: Lynn Rochester
Author: Emma Mcintosh

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