Is valpreventie kosteneffectief? Prof. Dr. Lieven Annemans Ghent University, Brussels University [email protected] [email protected] Maart 2014 1 Reactie van de overheden op de crisis Jaarlijkse groeicijfers vd gezondheidssector in diverse landen, excl. inflatie OECD health at a glance 2013 2 En sowieso al te weinig geld voor preventie! % of the total healthcare expenditure spent on prevention (EU 27) 3 Wat moet het doel zijn van een gezondheidsbeleid? “The primary goal of health (care) policy is to maximize the health of the population within the limits of the available resources, and within an ethical framework built on equity and solidarity principles”. Report of the Belgian EU Presidency, adopted by the EU Council of Ministers of Health in Dec 2010 4 Wat betekent dit voor investeringen in gezondheid? “We need to stimulate and make available those health interventions that offer a health benefit at an acceptable cost (i.e. are cost-effective), and fill unmet medical needs” - OECD 2003 - Report of the Belgian EU Presidency, adopted by the EU Council of Ministers of Health in Dec 2010 5 Cost  Kosten-effectiviteit! Not C-EFF “intervention” Current care C-EFF dominant Health effect (e.g. QALYs, avoided DALYs, …) 6 Voorbeeld: valpreventie (Noorwegen) +/- 320 euro) Hektoen et al. Scandinavian Journal of Public Health, 2009; 37: 584–589 The reduction in healthcare cost per individual for treating fallrelated injuries is 1.85 times higher than the cost of implementing a fall prevention programme for [frail] women aged 80 years living at home. 7 8 Enige nuancering nodig During the first 2 months, the intervention group received four home visits (1 hour per visit) by a physiotherapist who gave instruction in home-based training. For the next 10 months, the physiotherapist made telephone calls (20 minutes per call) to the participants every second month. The exercise programme lasted for 30 minutes and was completed three times a week for 1 year. In addition, the intervention group received a walking plan. Adherence not described Target population: frail elderly women > 80 years Absolute fall reduction 0.52 / year 9 The mean difference in NHS and personal social service costs between the groups was £-1,551 per patient over 1 year (95% CI: £-5,932 to £2,829) comparing the intervention and control groups. The intervention patients experienced on average 5.34 fewer falls over 12 months (95% CI: −7.06 to −3.62). The mean difference in QALYs was 0.070 (95% CI: −0.010 to 0.150) in favour of the intervention group. 10 Valpreventie bij iedereen? Een ander verhaal Australia, 2012 ‘grenswaarde’ in Australië: +/- 50,000 $ per QALY Group based exercise: what influences the results? Cost per QALY (AUD) Only those entering with "falls in last year" benefitted from the intervention, while all other subgroups did not experience this effect (Salkeld et al., 2000). It remains unclear where to draw the line between different groups in the study samples, depending on the individual case (Corrieri et al, 2011). Soms zelfs niet kosteneffectief in hoog-risico groepen Interventies met elkaar vergelijken ipv met ‘niets doen’ 16 1X/week resistance Versus balance training 2X/week resistance Versus balance training Absolute fall reduction 0.22 / 9 months 17 Bespreking • In het gezondheidsbeleid moet men steeds kosten en gezondheidseffecten afwegen • Wat de Engelsen, Australiërs, Canadezen etc… kunnen, dat kunnen wij toch ook? • Groot potentieel voor kostenbesparing indien bij de juiste personen en met de juiste modaliteiten • Sterke invloed van de exacte modaliteiten van de interventie en van de doelgroep • In een ideale wereld zijn er meer middelen om aan optimale valpreventie te doen, die dan (grotendeels) terugvloeien via minder zorguitgaven en leiden tot meer QALYs. • In een ideale wereld worden de modaliteiten voor optimale valpreventie vastgelegd via lessen die men trekt uit positieve en minder positieve internationale studies én uit eigen projecten. 18 Is valpreventie kosteneffectief? Prof. Dr. Lieven Annemans Ghent University, Brussels University [email protected] [email protected] Maart 2014 19