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Cost-effectiveness of the HiBalance training program for elderly with Parkinson's disease: analysis of data from a randomized controlled trial [with consumer summary]
Joseph C, Brodin N, Leavy B, Hagstromer M, Lofgren N, Franzen E
Clinical Rehabilitation 2019 Feb;33(2):222-232
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To determine the cost-effectiveness of the HiBalance training program for managing Parkinson's disease (PD)-related balance and gait disorders. DESIGN: Cost comparison design following the randomized controlled trial comparing a novel balance training intervention with care as usual. SUBJECTS: A total of 100 participants with mild-moderate PD were randomized to either the intervention (n = 51) or the control group (n = 49). INTERVENTION: A 10-week (three times per week), group-based, progressive balance training program, led by two physical therapists. MAIN OUTCOMES: All program costs were collected for both groups. Cost-utility was evaluated using quality-adjusted life years (QALYs) and cost-effectiveness measures were the Mini Balance Evaluation Systems Test (Mini-BESTest; assessing balance performance) and gait velocity. Incremental cost-effectiveness ratios were calculated and a probabilistic sensitivity analysis was conducted. RESULTS: The between-group difference in QALYs was 0.043 (95% confidence interval (CI) 0.011 to 0.075), favoring the intervention group. Between-group differences in balance performance and gait velocity were 2.16 points (95% CI 1.19 to 3.13) and 8.2 cm/second (95% CI 2.9 to 13.6), respectively, favoring the intervention group. The mean cost per participant in the intervention group was 16,222 SEK (Euro 1,649) compared to 2,696 SEK (Euro 274) for controls. The estimated incremental cost-effectiveness ratios were 314,558 SEK (Euro 31,969) for an additional QALY, 6,262 SEK (Euro 631) for one point improvement in balance performance, and 1,650 SEK (Euro 166) for 1 cm/second increase in gait velocity. Sensitivity analyses indicated a high probability (85%) of program success. CONCLUSION: In terms of QALYs, the HiBalance program demonstrated a high probability of cost-effectiveness in the short-term perspective when considering the willingness-to-pay thresholds used in Europe.

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