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

Xin, Y. et al. (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, 295. (doi: 10.1186/s12883-020-01852-8) (PMID:32781987) (PMCID:PMC7418432)

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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.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Xin, Miss Yiqiao and McIntosh, Professor Emma
Authors: Xin, Y., Ashburn, A., Pickering, R. M., Seymour, K. C., Hulbert, S., Fitton, C., Kunkel, D., Marian, I., Roberts, H. C., Lamb, S. E., Goodwin, V. A., Rochester, L., and McIntosh, E.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Journal Name:BMC Neurology
Publisher:BioMed Central
ISSN (Online):1471-2377
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in BMC Neurology 20: 295
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
168682A Randomised Controlled Trial of the Effectiveness of PDSAFE to prevent Falls among People with Parkinson's DiseaseEmma McIntoshNational Institute for Health Research (NIHR)10/57/21HW - Health Economics and Health Technology Assessment