Original Study Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization Inez Farag MSafSc (UNSW) a, *, Kirsten Howard PhD b , Alison J. Hayes PhD b , Manuela L. Ferreira PhD a , Stephen R. Lord PhD c , Jacqueline T. Close MD, FRACP c, d , Constance Vogler PhD e, f , Catherine M. Dean PhD g , Robert G. Cumming MD, PhD b , Cathie Sherrington PhD a a The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia b Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia c Neuroscience Research Australia, UNSW, Randwick, NSW, Australia d Prince of Wales Clinical School, UNSW, Randwick, NSW, Australia e Sydney Medical School, University of Sydney, Sydney, NSW, Australia g Faculty of Human Sciences, Macquarie University, North Ryde, NSW, Australia f Department of Aged Care, Royal North Shore Hospital Reserve Road, St Leonard’s, NSW, Australia Keywords: Older people hospitalization exercise programs fall prevention abstract Background: Older people who have been recently discharged from hospital are at increased risk of falls and deterioration in physical functioning. Objective: To investigate the cost-effectiveness of a 12-month home-exercise program for older adults after hospitalization. Method: An economic evaluation was conducted alongside a randomized controlled trial. The analysis was conducted from the health and community service provider perspective. A total of 340 people aged 60 years and older, with a recent hospital admission, were randomized into exercise and usual care control groups. Incremental costs per extra person showing improvement in mobility performance (using the Short Physical Performance Battery), per person indicating improvement in health (self-reported using a 3-point Likert scale) and per quality-adjusted life year (QALY) gained (utility measured using the EQ-5D) were estimated. Uncertainty was represented using cost-effectiveness acceptability curves. Subgroup analyses for participants with better cognition (above the median MMSE score of 28) also were undertaken. Results: The average cost of the intervention was $A751 per participant. The incremental cost- effectiveness of the program relative to usual care was $A22,958 per extra person showing an improvement in mobility, $A19,020 per extra person indicating an improvement in health, and $A77,403 per QALY. The acceptability curve demonstrates that the intervention had an 80% probability of being cost-effective relative to the control at a threshold of $A48,000 per extra person achieving mobility improvement and $A36,000 indicating an improvement in self-reported health. There was no threshold value at which the program can be considered as having an 80% probability of cost-effectiveness for the QALY outcome. Subgroup analyses for participants with better cognitive status indicated improved cost- effectiveness for all outcomes. Conclusion: The exercise intervention appeared to offer reasonable value for money for mobility out- comes and self-reported health status. Value for money for all measures was greater in the higher cognitive status subgroup. Ó 2015 AMDA e The Society for Post-Acute and Long-Term Care Medicine. The authors declare no conflicts of interest. The main trial received project grant funding from the Australian National Health and Medical Research Council for the submitted work (NHMRC ID: 457464). CS and SRL receive salary funding from Australian National Health and Medical Research Council Research Fellowships. The Australian National Health and Medical Research Council played no role in the production or approval of this manuscript. The researchers are independent of the funder. * Address correspondence to Inez Farag, MSafSc (UNSW), The George Institute for Global Health, The University of Sydney, Level 13, 321 Kent Street, Sydney 2000, Australia. E-mail address: ifarag@georgeinstitute.org.au (I. Farag). JAMDA journal homepage: www.jamda.com http://dx.doi.org/10.1016/j.jamda.2015.01.075 1525-8610/Ó 2015 AMDA e The Society for Post-Acute and Long-Term Care Medicine. JAMDA xxx (2015) 1e7