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Cost-Effectiveness and Value of Information Analysis of an Ambient Intelligent Geriatric Management (AmbIGeM) System Compared to Usual Care to Prevent Falls in Older People in Hospitals

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Abstract

Background

The Ambient Intelligent Geriatric Management (AmbIGeM) system combines wearable sensors with artificial intelligence to trigger alerts to hospital staff before a fall. A clinical trial found no effect across a heterogenous population, but reported a reduction in the injurious falls rate in a post hoc analysis of patients on Geriatric Evaluation Management Unit (GEMU) wards. Cost-effectiveness and Value of Information (VoI) analyses of the AmbIGeM system in GEMU wards was undertaken.

Methods

An Australian health-care system perspective and 5-year time horizon were used for the cost-effectiveness analysis. Implementation costs, inpatient costs and falls data were collected. Injurious falls were defined as causing bruising, laceration, fracture, loss of consciousness, or if the patient reported persistent pain. To compare costs and outcomes, generalised linear regression models were used to adjust for baseline differences between the intervention and usual care groups. Bootstrapping was used to represent uncertainty. For the VoI analysis, 10,000 different sample sizes with randomly sampled values ranging from 1 to 50,000 were tested to estimate the optimal sample size of a new trial that maximised the Expected Net Benefits of Sampling.

Results

An adjusted 0.036 fewer injurious falls (adjusted rate ratio of 0.56) and AUD$4554 lower costs were seen in the intervention group. However, uncertainty that the intervention is cost effective for the prevention of an injurious fall was present at all monetary values of this effectiveness outcome. A new trial with a sample of 4376 patients was estimated to maximise the Expected Net Benefit of Sampling, generating a net benefit of AUD$186,632 at a benefit-to-cost ratio of 1.1.

Conclusions

The benefits to cost ratio suggests that a new trial of the AmbIGeM system in GEMU wards may not be high-value compared to other potential trials, and that the system should be implemented. However, a broader analysis of options for preventing falls in GEMU is required to fully inform decision making.

Trial Registration

Australian and New Zealand Clinical Trial Registry (ACTRN 12617000981325).

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Acknowledgements

We would like to thank SA Health (Tomi Adejoro) and WA Health (Ian Massingham) for support and provision of data. We would also like to acknowledge the clinical, administrative and information technology staff from both hospitals, the research staff and students that supported the conduct of the trial.

Author information

Authors and Affiliations

  1. Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia

    Clarabelle T. Pham & Jonathan Karnon

  2. Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia

    Renuka Visvanathan

  3. School of Health and Related Research, The University of Sheffield, Sheffield, UK

    Mark Strong

  4. Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, Exeter, UK

    Edward C. F. Wilson

  5. Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia

    Kylie Lange

  6. Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, SA, Australia

    Joanne Dollard

  7. The Auto-ID Lab, The School of Computer Science, University of Adelaide, Adelaide, SA, Australia

    Damith Ranasinghe

  8. Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, VIC, Australia

    Keith Hill

  9. College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia

    Anne Wilson

Authors
  1. Clarabelle T. Pham
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  2. Renuka Visvanathan
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  3. Mark Strong
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  5. Kylie Lange
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  6. Joanne Dollard
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  7. Damith Ranasinghe
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  8. Keith Hill
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  9. Anne Wilson
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  10. Jonathan Karnon
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Corresponding author

Correspondence to Clarabelle T. Pham.

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Funding

This study was funded by a project grant (1082197) from the National Health and Medical Research Council of Australia.

Conflicts of Interest

Previously, there was a patent filed (mid-2013) by Drs Ranasinghe and Visvanathan titled, “System, method, software application and data signal for determining movement” but this has since lapsed. Professor Visvanathan is the Head of Unit of the Aged & Extended Care Services at The Queen Elizabeth Hospital in South Australia within which the GEMU ward is a service. Professor Visvanathan is providing advice to Live 24/7, a start-up based in San Jose, USA. Dr Dollard was awarded The Hospital Research Foundation Research Travel Award and Faculty of Health and Medical Sciences (University of Adelaide) Research Travel Award in 2017 to attend AmbIGeM related meetings. The remaining authors declare no other conflicts of interest.

Author Contributions

CP and JK designed and conducted the economic evaluation and value of information analysis, and contributed to the cost data collection, data interpretation and drafting of the manuscript. MS and EW contributed to the design and interpretation of the value of information analysis and drafting of the manuscript. RV and KH equally contributed to the study design, selecting participating sites, conducting the research, data collection, data interpretation and drafting of the manuscript. DR contributed to the technology design and implementation, conducting the research, data collection, data interpretation and drafting of the manuscript. KL designed and conducted the statistical analysis and contributed to interpretation and drafting of the manuscript. JD and AW were involved in the conduct of the study, data collection, data interpretation and drafting the manuscript.

Data Availability

Requests for health economics data should be directed to the senior author (jonathan.karnon@flinders.edu.au) and will require collaboration with the chief investigator team. Any requests will be assessed for scientific rigor (by a panel consisting of JK, RV, KH and DR) and given the involvement of hospital patient data, the request must first meet ethics request guidelines and be approved by the ethics committees of TQEH/Lyell McEwin Hospital (LMH)/Modbury Hospital (MH), Curtin University, and SCGH. The requestor will be responsible for preparing documentation to the standard required to meet the conditions of the various ethics committees. A data sharing agreement will be necessary and funding requested for facilitation of this process and provision of data. Given the multiple analyses planned as well as underway currently, data sharing is at this stage embargoed for a further 2 years.

Ethics Approval

Ethics and governance approval was granted by the TQEH/Lyell McEwin Hospital /Modbury Hospital (HREC/15/TQEH/17), Curtin University (HRE2017-0449) and SCGH (PRN 2015-110).

Consent to Participate

A waiver of consent was approved in Western Australia and opt-out consent was approved in South Australia.

Consent for Publication

A waiver of consent was approved in Western Australia and opt-out consent was approved in South Australia.

Code Availability

The authors can provide more details upon request.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 270 KB)

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Pham, C.T., Visvanathan, R., Strong, M. et al. Cost-Effectiveness and Value of Information Analysis of an Ambient Intelligent Geriatric Management (AmbIGeM) System Compared to Usual Care to Prevent Falls in Older People in Hospitals. Appl Health Econ Health Policy 21, 315–325 (2023). https://doi.org/10.1007/s40258-022-00773-6

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