Journal of the American Geriatrics Society

Volume 50, Issue 8 p. 1381-1388

Cost-Effectiveness of Preventive Occupational Therapy for Independent-Living Older Adults

Joel Hay PhD,

Joel Hay PhD

Department of Pharmaceutical Economics and Policy, School of Pharmacy,

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Laurie LaBree MS,

Laurie LaBree MS

Statistical Consultation and Research Center, Department of Preventive Medicine, Keck School of Medicine, and

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Roger Luo PhD,

Roger Luo PhD

Department of Pharmaceutical Economics and Policy, School of Pharmacy,

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Florence Clark PhD, OTR,

Florence Clark PhD, OTR

Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.

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Mike Carlson PhD,

Mike Carlson PhD

Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.

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Deborah Mandel MS, OTR,

Deborah Mandel MS, OTR

Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.

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Ruth Zemke PhD, OTR,

Ruth Zemke PhD, OTR

Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.

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Jeanne Jackson PhD, OTR,

Jeanne Jackson PhD, OTR

Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.

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Stanley P. Azen PhD,

Stanley P. Azen PhD

Statistical Consultation and Research Center, Department of Preventive Medicine, Keck School of Medicine, and

Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.

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Joel Hay PhD,

Joel Hay PhD

Department of Pharmaceutical Economics and Policy, School of Pharmacy,

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Laurie LaBree MS,

Laurie LaBree MS

Statistical Consultation and Research Center, Department of Preventive Medicine, Keck School of Medicine, and

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Roger Luo PhD,

Roger Luo PhD

Department of Pharmaceutical Economics and Policy, School of Pharmacy,

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Florence Clark PhD, OTR,

Florence Clark PhD, OTR

Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.

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Mike Carlson PhD,

Mike Carlson PhD

Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.

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Deborah Mandel MS, OTR,

Deborah Mandel MS, OTR

Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.

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Ruth Zemke PhD, OTR,

Ruth Zemke PhD, OTR

Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.

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Jeanne Jackson PhD, OTR,

Jeanne Jackson PhD, OTR

Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.

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Stanley P. Azen PhD,

Stanley P. Azen PhD

Statistical Consultation and Research Center, Department of Preventive Medicine, Keck School of Medicine, and

Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.

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First published: 07 August 2002

https://doi.org/10.1046/j.1532-5415.2002.50359.x

Citations: 90

Address correspondence to Stanley Azen, PhD, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1540 Alcazar Street CHP-218, Los Angeles CA 90033. E-mail: [email protected]

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Abstract

OBJECTIVES: To evaluate the cost-effectiveness of a 9-month preventive occupational therapy (OT) program in the Well-Elderly Study: a randomized trial in independent-living older adults that found significant health, function, and quality of life benefits attributable to preventive OT.

DESIGN: A randomized trial.

SETTING: Two government-subsidized apartment complexes.

PARTICIPANTS: One hundred sixty-three culturally diverse volunteers aged 60 and older.

INTERVENTION: An OT group, a social activity group (active control), and a nontreatment group (passive control).

MEASUREMENTS: Use of healthcare services was determined by telephone interview during and after the treatment phase. A conversion algorithm was applied to the RAND 36-item Short Form Health Survey to derive a preference-based health-related quality of life index, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio for preventive OT relative to the combined control group.

RESULTS: Costs for the 9-month OT program averaged $548 per subject. Postintervention healthcare costs were lower for the OT group ($967) than for the active control group ($1,726), the passive control group ($3,334), or a combination of the control groups ($2,593). The quality of life index showed a 4.5% QALY differential (OT vs combined control), P < .001. The cost per QALY estimates for the OT group was $10,666 (95% confidence interval = $6,747–$25,430). For the passive and active control groups, the corresponding costs per QALY were $13,784 and $7,820, respectively.

CONCLUSION: In this study, preventive OT demonstrated cost-effectiveness in conjunction with a trend toward decreased medical expenditures.

REFERENCES

1 U.S. Bureau of the Census. Statistical Abstract of the United States. Washington, DC: U.S. Government Printing Office, 1997.
Google Scholar
2 Fisher B. Successful aging, life satisfaction, and generativity in later life. Int J Aging Hum Dev 1995; 41: 239–250.
10.2190/HA9X-H48D-9GYB-85XW
CASPubMedWeb of Science®Google Scholar
3 Clark F, Azen SP, Zemke R et al. Occupational therapy for independent-living older adults: A randomized controlled trial. JAMA 1997; 278: 1321–1326.
10.1001/jama.1997.03550160041036
CASPubMedWeb of Science®Google Scholar
4 Clark F, Azen SP, Carlson M et al. Embedding health-promoting changes into the daily lives of independent-living older adults: Long-term follow-up of occupational therapy intervention. J Gerontol B Psychol Sci Soc Sci 2001; 56B: P60–P63.
10.1093/geronb/56.1.P60
Web of Science®Google Scholar
5 Jackson J, Carlson M, Zemke R et al. Occupation in lifestyle redesign: The USC Well Elderly Study Occupational Therapy Program. Am J Occup Ther 1998; 52: 326–336.
10.5014/ajot.52.5.326
CASPubMedWeb of Science®Google Scholar
6 Hays RD, Sherbourne CD, Mazel RM. The RAND 36-item Health Survey 1.0. Health Econ 1993; 2: 217–227.
10.1002/hec.4730020305
CASPubMedGoogle Scholar
7 Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36) I. Conceptual framework and item selection. Med Care 1992; 30: 473–481.
10.1097/00005650-199206000-00002
CASPubMedWeb of Science®Google Scholar
8 Ware JE, Snow KK, Kosinski M et al. SF-36 Health Survey: Manual and Interpretation Guide. Boston, MA: The Health Institute, New England Medical Center, 1993.
Google Scholar
9 Jette AM, Cleary PD. Functional disability assessment. Phys Ther 1987; 67: 1854–1859.
10.1093/ptj/67.12.1854
CASPubMedWeb of Science®Google Scholar
10 Wood V, Wylie ML, Sheafor B. An analysis of a short self-reported measure of life satisfaction: Correlation with rater judgments. J Gerontol 1969; 24: 465–469.
10.1093/geronj/24.4.465
CASPubMedWeb of Science®Google Scholar
11 Radloff L. The CES-D Scale: A self-report depression scale for research in the general population. Appl Psychological Meas 1977; 1: 385–401.
10.1177/014662167700100306
PubMedWeb of Science®Google Scholar
12 Stewart AL, Hays RD, Ware JE. The MOS Short-form General Health Survey. Med Care 1988; 26: 724–735.
10.1097/00005650-198807000-00007
CASPubMedWeb of Science®Google Scholar
13 Hays V, Morris J, Wolfe C et al. The SF-36 Health Survey Questionnaire: Is it suitable for use with older adults? Age Ageing 1995; 24: 120–125.
10.1093/ageing/24.2.120
PubMedWeb of Science®Google Scholar
14 McHorney CA, Ware JE, Rogers W et al. The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts. Results from the Medical Outcomes Study. Med Care 1992; 30(5 Suppl): 253–265.
Web of Science®Google Scholar
15 McHorney CA. Measuring and monitoring general health status in elderly persons: Practical and methodological issues in using the SF-36 health survey. Gerontologist 1996; 30: 571–583.
10.1093/geront/36.5.571
Google Scholar
16 Bult JR, Hunink MGM, Tsevat J et al. Heterogeneity of the relationship between the time trade-off and Short Form-36 for HIV infected and primary care patients. Med Care 1998; 36: 523–532.
10.1097/00005650-199804000-00008
CASPubMedWeb of Science®Google Scholar
17 Brazier J, Usherwood T, Harper R et al. Deriving a preference-based single index from the UK SF-36 health survey. J Clin Epidemiol 1998; 51: 115–128.
10.1016/S0895-4356(98)00103-6
CASWeb of Science®Google Scholar
18 Lenert LA, Sherbourne CD, Sugar C et al. Estimation of utilities for the effects of depression from the SF-12. Med Care 2000; 38: 763–770.DOI: 10.1097/00005650-200007000-00008
10.1097/00005650-200007000-00008
CASPubMedWeb of Science®Google Scholar
19 Hays RD, Morales LS. The RAND-36 measure of health-related quality of life. Ann Med 2001; 332: 350–357.
10.3109/07853890109002089
CASWeb of Science®Google Scholar
20 Nichol MB, Sengupta N, Globe DR. Evaluating quality-adjusted life years: Estimation of the Health Utility Index (HUI) from the SF-36. Med Decis Making 2001; 21: 19–26.
10.1177/02729890122062352
Web of Science®Google Scholar
21 Schoenbaum M, Unutzer J, Sherbourne C et al. Cost-effectiveness of practice-initiated quality improvement for depression: Results of a randomized controlled trial. JAMA 2001; 286: 1325–1330.
10.1001/jama.286.11.1325
CASPubMedWeb of Science®Google Scholar
22 Gold M, Siegel J, Russell L et al. Cost Effectiveness in Health and Medicine. New York: Oxford University Press, 1996.
10.1093/oso/9780195108248.001.0001
Google Scholar
23 Fryback DG, Lawrence WF, Martin PA et al. Predicting quality of well-being scores from the SF-36. Med Decis Making 1997; 17: 1–9.
10.1177/0272989X9701700101
CASPubMedWeb of Science®Google Scholar
24 Garber AM, Phelps CE. Economic foundations of cost-effectiveness analysis. J Health Econ 1997; 16: 1–31.
10.1016/S0167-6296(96)00506-1
PubMedWeb of Science®Google Scholar
25 Graham JD, Corso PS, Morris JM et al. Evaluating the cost-effectiveness of clinical and public health measures. Annu Rev Public Health 1998; 19: 125–152.
10.1146/annurev.publhealth.19.1.125
CASPubMedWeb of Science®Google Scholar
26 Hays RD, Alonso J, Coons SJ. Possibilities for summarizing health-related quality of life when using a profile instrument. In: M Staquet, R Hays, P Fayers, eds. Quality of Life Assessment in Clinical Trials: Methods and Practice. New York, NY: Oxford University Press, 1998, pp 143–153.
Web of Science®Google Scholar

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Volume50, Issue8

August 2002

Pages 1381-1388

Cost-Effectiveness of Preventive Occupational Therapy for Independent-Living Older Adults

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