Cost-Effectiveness of a Therapeutic Tai Ji Quan Fall Prevention Intervention for Older Adults at High Risk of Falling

Abstract

Background Data on the cost-effectiveness of proven fall prevention exercise interventions are limited. We aimed to establish the cost-effectiveness of Tai Ji Quan: Moving for Better Balance (TJQMBB) compared with a conventional exercise intervention for older adults at high risk of falling. Methods We conducted a trial-based cost-effectiveness analysis involving 670 older adults who had a history of falling or impaired mobility. Participants received one of three interventions—TJQMBB, multimodal exercise, or stretching exercise (control)—each of which was implemented twice weekly for 24 weeks. The primary cost-effectiveness measure was the incremental cost per additional fall prevented, comparing TJQMBB and multimodal exercise to Stretching and TJQMBB to multimodal exercise, with a secondary measure of incremental cost per additional quality-adjusted life-year (QALY) gained. The intervention was conducted between February 2015 and January 2018, and cost-effectiveness was estimated from a health care system perspective over a 6-month time horizon. Results The total cost to deliver the TJQMBB intervention was $202,949 (an average of $906 per participant); for multimodal exercise, it was $223,849 ($1,004 per participant); and for Stretching, it was $210,468 ($903 per participant). Incremental cost-effectiveness ratios showed that the multimodal exercise was cost-effective ($850 per additional fall prevented; $27,614 per additional QALY gained) relative to Stretching; however, TJQMBB was the most economically dominant strategy (ie, having lower cost and being clinically more efficacious) compared with multimodal and stretching exercises with regard to cost per additional fall prevented and per additional QALY gained. TJQMBB had a 100% probability of being cost-effective, relative to Stretching, at a threshold of $500 per each additional fall prevented and $10,000 per additional QALY gained. Sensitivity analyses showed the robustness of the results when extreme cases, medical costs only, and missing data were considered. Conclusions Among community-dwelling older adults at high risk for falls, TJQMBB is a cost-effective means of reducing falls compared with conventional exercise approaches. Trial Registration Clinicaltrials.gov (NCT02287740).

The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing

“…32 Li and Harmer found that Tai Chi was both effective for reducing fall risk, 41 as well as a cost-effective method for reducing fall related injury in older adults with high risk of falling. 42 Similar findings have been reported across a broad range of older adults. 25,[43][44][45] However, in our study, there was no observed difference in fallrelated injuries among Tai Chi and HE groups.…”

Trends and Characteristics of Tai Chi and Qi Gong Use among U.S. Adults: Results from the 2007-2017 NHIS

“…One possible explanation may be because TCQ has been used as costeffective healing/exercise therapies for health promotion and disease prevention. [39][40][41] Another interesting nding in our study is that the more signi cant change is for people who have been physically inactive compared with people who have been doing some physical activities and/or regular physical activities from 2012 to 2017. This may be because more and more people are aware of the unique qualities of TCQ, as they involve the form of physical activity (i.e., graceful body movement).…”

Effectiveness ofTai Ji Quanvs Multimodal and Stretching Exercise Interventions for Reducing Injurious Falls in Older Adults at High Risk of Falling

“…Finally, our study also suggests that although both TJQMBB and multimodal exercise are associated with reduced incidence of injurious falls, the former has the additional advantage of requiring few resources for program implementation (eg, no equipment required, low costs, 20 and minimal space needed), thereby enhancing return on investment 28 and cost-effectiveness. 29 …”