Cost-Effectiveness of a Community-Based Frailty Intervention in Singapore: A Pilot Economic Evaluation of the Say No To Frailty Program

Abstract

Background: Frailty in older adults is associated with increased healthcare utilisation, functional decline, and poorer quality of life. The Say No To Frailty (SNTF) program is a multicomponent, community-based intervention designed to address modifiable risk factors of frailty. This study assessed the cost-effectiveness of the SNTF program compared with usual care, and compared cost-effectiveness between delivery by Allied Health Professionals (AHPs) and non–AHP facilitators. Methods: A pilot economic evaluation was conducted using data from the second phase of a larger cluster-randomised controlled trial. Health outcomes were measured using the EQ-5D-5L, with Quality-Adjusted Life Years (QALYs) calculated over 12 months. Costs included program-related and frailty-related healthcare utilisation. Incremental cost-effectiveness ratios (ICERs) were estimated by comparing intervention arms with usual care. Regression analyses were performed to adjust for baseline differences in health utility. Results: Thirty participants from 3 participating centres participated in this study. Both SNTF intervention arms (AHP-led = 7, non-AHP-led = 10) generated higher QALYs than usual care (n = 13) over 12 months, associated with higher costs. The AHP-led arm demonstrated more favourable cost-effectiveness estimates than the non–AHP-led arm when compared with usual care. However, adjusted incremental QALY differences were not statistically significant, and ICER estimates were sensitive to extreme costs; therefore, findings should be considered preliminary. Conclusions: The SNTF program, particularly when delivered by AHPs, shows potential for cost-effectiveness in community-dwelling