2017 年 23 巻 2 号 p. 3-12
Background: The cost-effectiveness of intervention programs associated with different population characteristics remains unclear, especially in mildly disabled older populations. The purpose of this study was to conduct a cost-utility analysis of a disability prevention program for older adults with mild disabilities in the urban area of Tokyo, Japan from a long-term care system perspective.
Method: In a single blinded, before‒after trial, we recruited 128 mildly disabled participants (age, ≥65 years) who had enrolled in a center-based preventive program under the Japanese long-term care insurance system in Tokyo. All participants attended training sessions (1‒2 session(s)/week; 75 minutes/session), comprising both resistance and aerobic training that were guided and supervised by physiotherapists. A cost-utility analysis using QALY based on EQ-5D-5L and EQ-VAS were performed. Long-term care costs between baseline and follow-up were assessed from a long-term care system perspective. Intervention and nursing-care costs were calculated according to the Japanese long-term care insurance system rates. A cost-effectiveness accessibility curve was constructed, and a probability sensitivity analysis controlling for the influence of the mode of QALY calculation was performed.
Results: 74 participants were included in the analysis. The base costs of total mean ICER (EQ-5D-5L) and ICER (EQ-VAS) were 1,144,020.0 ± 716,568.1 and 1,149,829.1 ± 652,428.8 yen, respectively. The probability of reaching the accepted cost-effectiveness threshold of JPY/5,000,000 per QALY is significantly higher for all simulations.
Conclusion: This study demonstrated that a center-based disability preventive program is likely to be cost-effective. Future research should include larger sample sizes, different participant characteristics, such as moderately disabled and frail participants, and different settings, such as home- or center-based care.
