Osteoporosis International

, Volume 22, Issue 5, pp 1355–1366

Economic evaluation of dose–response resistance training in older women: a cost-effectiveness and cost-utility analysis

  • J. C. Davis
  • C. A. Marra
  • M. C. Robertson
  • K. M. Khan
  • M. Najafzadeh
  • M. C. Ashe
  • T. Liu-Ambrose
Original Article

Abstract

Summary

We estimated the incremental cost-effectiveness of a once-weekly or twice-weekly resistance training intervention compared with balance and tone classes in terms of falls prevented and quality-adjusted life years (QALYs) gained. Both resistance training interventions were more likely to save health care resource money and offer better health outcomes for falls prevention than balance and tone classes.

Introduction

This study aims to estimate the incremental cost-effectiveness and cost-utility of a once-weekly or twice-weekly resistance training intervention compared with twice-weekly balance and tone classes in terms of falls prevented and QALYs gained.

Methods

Economic evaluation was conducted concurrently with a three-arm randomized controlled trial including 155 community-dwelling women aged 65 to 75 years, Mini Mental State Examination ≥24, and visual acuity 20/40 or better. Participants received the once-weekly resistance training (n = 54), the twice-weekly resistance training (n = 51) or the twice-weekly balance and tone (the comparator) classes (n = 50) for 1 year. Measurements included the number of falls for each participant, healthcare resource utilization, and associated costs over 9 months; health status was assessed using the EQ-5D and SF-6D to calculate QALYs.

Results

Based on the point estimates from our base case analysis, we found that both once- and twice-weekly resistance training groups were less costly (p < 0.05) and more effective than twice-weekly balance and tone classes. The incremental QALYs assessed using the SF-6D were 0.003 for both the once- and twice-weekly resistance training groups, compared with the twice-weekly balance and tone classes. The incremental QALYs assessed using the EQ-5D were 0.084 for the once-weekly and 0.179 for the twice-weekly resistance training groups, respectively, compared with the twice-weekly balance and tone classes.

Conclusions

An individually tailored resistance training intervention delivered once or twice weekly provided better value for money for falls prevention than balance and tone classes.

Keywords

Cost-effectiveness Cost-utility Economic evaluation Falls Older adults Resistance training 

References

  1. 1.
    Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475PubMedCrossRefGoogle Scholar
  2. 2.
    Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337:1279–1284PubMedCrossRefGoogle Scholar
  3. 3.
    Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E (2001) Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 12:271–278PubMedCrossRefGoogle Scholar
  4. 4.
    Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707PubMedCrossRefGoogle Scholar
  5. 5.
    Nevitt MC, Cummings SR, Hudes ES (1991) Risk factors for injurious falls: a prospective study. J Gerontol 46:M164–M170PubMedGoogle Scholar
  6. 6.
    Scuffham P, Chaplin S, Legood R (2003) Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health 57:740–744PubMedCrossRefGoogle Scholar
  7. 7.
    Orr R, Raymond J, Fiatarone Singh M (2008) Efficacy of progressive resistance training on balance performance in older adults: a systematic review of randomized controlled trials. Sports Med 38:317–343PubMedCrossRefGoogle Scholar
  8. 8.
    Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev CD007146Google Scholar
  9. 9.
    Liu-Ambrose T, Khan KM, Eng JJ, Janssen PA, Lord SR, McKay HA (2004) Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial. J Am Geriatr Soc 52:657–665PubMedCrossRefGoogle Scholar
  10. 10.
    Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. PLoS Med 7:e1000251PubMedCrossRefGoogle Scholar
  11. 11.
    Barrett CJ, Smerdely P (2002) A comparison of community-based resistance exercise and flexibility exercise for seniors. Aust J Physiother 48:215–219PubMedGoogle Scholar
  12. 12.
    Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ (1994) Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. JAMA 272:1909–1914PubMedCrossRefGoogle Scholar
  13. 13.
    Orr R, de Vos NJ, Singh NA, Ross DA, Stavrinos TM, Fiatarone-Singh MA (2006) Power training improves balance in healthy older adults. J Gerontol A Biol Sci Med Sci 61:78–85PubMedGoogle Scholar
  14. 14.
    Timonen L, Rantanen T, Ryynanen OP, Taimela S, Timonen TE, Sulkava R (2002) A randomized controlled trial of rehabilitation after hospitalization in frail older women: effects on strength, balance and mobility. Scand J Med Sci Sports 12:186–192PubMedCrossRefGoogle Scholar
  15. 15.
    Robertson MC, Devlin N, Gardner MM, Campbell AJ (2001) Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1. Randomised controlled trial. BMJ 322:697–701PubMedCrossRefGoogle Scholar
  16. 16.
    Robertson MC, Devlin N, Scuffham P, Gardner MM, Buchner DM, Campbell AJ (2001) Economic evaluation of a community based exercise programme to prevent falls. J Epidemiol Community Health 55:600–606PubMedCrossRefGoogle Scholar
  17. 17.
    Robertson MC, Gardner MM, Devlin N, McGee R, Campbell AJ (2001) Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 2. Controlled trial in multiple centres. BMJ 322:701–704PubMedCrossRefGoogle Scholar
  18. 18.
    Liu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC (2010) Resistance training and executive functions: a 12-month randomized controlled trial. Arch Intern Med 170:170–178PubMedCrossRefGoogle Scholar
  19. 19.
    Neumann PJ, Goldie SJ, Weinstein MC (2000) Preference-based measures in economic evaluation in health care. Annu Rev Public Health 21:587–611PubMedCrossRefGoogle Scholar
  20. 20.
    Liu-Ambrose T, Donaldson MG, Ahamed Y, Graf P, Cook WL, Close J, Lord SR, Khan KM (2008) Otago home-based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial. J Am Geriatr Soc 56:1821–1830PubMedCrossRefGoogle Scholar
  21. 21.
    Colcombe S, Kramer AF (2003) Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci 14:125–130PubMedCrossRefGoogle Scholar
  22. 22.
    Briggs A, Clark T, Wolstenholme J, Clarke P (2003) Missing... presumed at random: cost-analysis of incomplete data. Health Econ 12:377–392PubMedCrossRefGoogle Scholar
  23. 23.
    Manca A, Palmer S (2005) Handling missing data in patient-level cost-effectiveness analysis alongside randomised clinical trials. Appl Health Econ Health Policy 4:65–75PubMedCrossRefGoogle Scholar
  24. 24.
    Oostenbrink JB, Al MJ (2005) The analysis of incomplete cost data due to dropout. Health Econ 14:763–776PubMedCrossRefGoogle Scholar
  25. 25.
    Oostenbrink JB, Al MJ, Rutten-van Molken MP (2003) Methods to analyse cost data of patients who withdraw in a clinical trial setting. Pharmacoeconomics 21:1103–1112PubMedCrossRefGoogle Scholar
  26. 26.
    Briggs AH, Gray AM (1999) Handling uncertainty when performing economic evaluation of healthcare interventions. Health Technol Assess 3:1–134PubMedGoogle Scholar
  27. 27.
    Laska EM, Meisner M, Siegel C (1997) Statistical inference for cost-effectiveness ratios. Health Econ 6:229–242PubMedCrossRefGoogle Scholar
  28. 28.
    Fenwick E, Claxton K, Sculpher M (2001) Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ 10:779–787PubMedCrossRefGoogle Scholar
  29. 29.
    Marra CA, Woolcott JC, Kopec JA, Shojania K, Offer R, Brazier JE, Esdaile JM, Anis AH (2005) A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Soc Sci Med 60:1571–1582PubMedCrossRefGoogle Scholar
  30. 30.
    Drummond MF, Sculpher MJ, Torrance GW, O’Brien B, Stoddart GL (2005) Methods for the economic evaluation for health care programmes, 3rd edn. Oxford University Press, New York, United States of AmericaGoogle Scholar
  31. 31.
    Carter ND, Khan KM, McKay HA, Petit MA, Waterman C, Heinonen A, Janssen PA, Donaldson MG, Mallinson A, Riddell L, Kruse K, Prior JC, Flicker L (2002) Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. CMAJ 167:997–1004PubMedGoogle Scholar
  32. 32.
    Claxton K (1999) The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies. J Health Econ 18:341–364PubMedCrossRefGoogle Scholar
  33. 33.
    Rizzo JA, Baker DI, McAvay G, Tinetti ME (1996) The cost-effectiveness of a multifactorial targeted prevention program for falls among community elderly persons. Med Care 34:954–969PubMedCrossRefGoogle Scholar
  34. 34.
    Salkeld G, Cumming RG, O’Neill E, Thomas M, Szonyi G, Westbury C (2000) The cost effectiveness of a home hazard reduction program to reduce falls among older persons. Aust N Z J Public Health 24:265–271PubMedCrossRefGoogle Scholar
  35. 35.
    McCartney N, Hicks AL, Martin J, Webber CE (1995) Long-term resistance training in the elderly: effects on dynamic strength, exercise capacity, muscle, and bone. J Gerontol A Biol Sci Med Sci 50:B97–B104PubMedGoogle Scholar
  36. 36.
    Glick HA, Doshi JA, Sonnad SA, Polsky D (2007) Economic evaluation in clinical trials. Oxford University Press, New YorkGoogle Scholar
  37. 37.
    Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC (2008) Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 56:2234–2243PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • J. C. Davis
    • 1
  • C. A. Marra
    • 1
    • 3
  • M. C. Robertson
    • 1
    • 2
  • K. M. Khan
    • 1
  • M. Najafzadeh
    • 3
  • M. C. Ashe
    • 1
  • T. Liu-Ambrose
    • 1
    • 4
  1. 1.Centre for Hip Health and MobilityUniversity of British ColumbiaVancouverCanada
  2. 2.Department of Medical & Surgical Sciences, Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
  3. 3.Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverCanada
  4. 4.Department of Physical Therapy, Brain Research Centre UBC, Centre for Hip Health and MobilityVCHRIVancouverCanada

Personalised recommendations