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Randomized Controlled Trial
. 2020 Aug 11;20(1):295.
doi: 10.1186/s12883-020-01852-8.

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

Yiqiao Xin  1 , Ann Ashburn  2 , Ruth M Pickering  3 , Kim Chivers Seymour  2 , Sophia Hulbert  2 , Carolyn Fitton  2 , Dorit Kunkel  2 , Ioana Marian  3 , Helen C Roberts  3 , Sarah E Lamb  4 , Victoria A Goodwin  5 , Lynn Rochester  6 , Emma McIntosh  7 ; PDSAFE Collaborative group
Collaborators, Affiliations
Randomized Controlled Trial

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

Yiqiao Xin et al. BMC Neurol. .

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.

Keywords: Cost; Cost-effectiveness; Parkinson’s; Physiotherapist; Quality of life.

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Conflict of interest statement

Dr. Goodwin reports grants from National Institute for Health Research, during the conduct of the study. Prof. Lamb reports grants from NIHR Health technology Assessment Programme during the conduct of this study. Prof. Lamb was a member of the HTA Additional Capacity Funding Board, HTA End of Life Care and Add-on Studies, HTA Prioritisation Group, HTA Trauma Board during this study. Prof. McIntosh is a member of the NIHR Public Health Research Funding board. All other authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
EQ-5D-3L utility values at baseline, 3, 6, and 12 months
Fig. 2
Fig. 2
Cost-effectiveness plane (a) and cost-effectiveness acceptability curve (b) of the PDSAFE intervention vs. usual care
See this image and copyright information in PMC

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References

    1. Partridge N, Scadding J. The James Lind Alliance: patients and clinicians should jointly identify their priorities for clinical trials. Lancet. 2004;364(9449):1923–1924. - PubMed
    1. Deane KHO, Flaherty H, Daley DJ, Pascoe R, Penhale B, Clarke CE, et al. Priority setting partnership to identify the top 10 research priorities for the management of Parkinson's disease. BMJ Open. 2014;4:e006434. - PMC - PubMed
    1. Kalilani L, Asgharnejad M, Palokangas T, Durgin T. Comparing the incidence of falls/fractures in Parkinson's disease patients in the US population. PLoS One. 2016;11(9):e0161689. - PMC - PubMed
    1. Thurman DJ, Stevens JA, Rao JK. Practice parameter: assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the quality standards Subcommittee of the American Academy of neurology. Neurology. 2008;70(6):473–479. - PubMed
    1. Genever RW, Downes TW, Medcalf P. Fracture rates in Parkinson's disease compared with age- and gender-matched controls: a retrospective cohort study. Age Ageing. 2005;34(1):21–24. - PubMed

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