Open Access

Background Vertigo, dizziness or balance disorders (VDB) are common leading symptoms in older people, which can have a negative impact on their mobility and participation in daily live, yet, diagnosis is challenging and specific treatment is often insufficient. An evidence-based, multidisciplinary care pathway (CPW) in primary care was developed and pilot tested in a previous study. The aim of the present study is to evaluate the effectiveness and safety of the CPW in terms of improving mobility and participation in community-dwelling older people with VDB in primary care. Methods For this multicentre cluster randomised controlled clinic trial, general practitioners (GP) will be recruited in two regions of Germany. A total of 120 patients over 60 years old with VDB will be included. The intervention is an algorithmized CPW. GPs receive a checklist for standardise clinical decision making regarding diagnostic screening and treatment of VDB. Physiotherapists (PT) receive a decision tree for evidence-based physiotherapeutic clinical reasoning and treatment of VDB. Implementation strategies comprises educational trainings as well as a workshop to give a platform for exchange for the GPs and PTs, an information meeting and a pocket card for home care nurses and informal caregivers and telephone peer counselling to give all participants the capability, opportunity and the motivation to apply the intervention. In order to ensure an optimised usual care in the control group, GPs get an information meeting addressing the national guideline. The primary outcome is the impact of VDB on participation and mobility of patients after 6 month follow-up, assessed using the Dizziness Handicap Inventory (DHI) questionnaire. Secondary outcomes are physical activity, static and dynamic balance, falls and fear of falling as well as quality of life. We will also evaluate safety and health economic aspects of the intervention. Behavioural changes of the participants as well as barriers, facilitating factors and mechanisms of impact of the implementation will be investigated with a comprehensive process evaluation in a mixed-methods design. Discussion With our results, we aim to improve evidence-based health care of community-dwelling older people with VDB in primary care.

Abstract Background Vertigo, dizziness and balance disorders affect over half of adults aged 65 and older. The MobilE-PHY2 study, conducted in Germany, evaluated the effectiveness of an evidence-based, multidisciplinary care pathway for this population. From a health economic perspective, the intervention was expected to increase outpatient and physiotherapy costs while reducing resource utilisation in other healthcare areas and improving patient-relevant outcomes. Objective This health economic evaluation examined the cost-effectiveness of the care pathway compared to optimised routine care. Incremental costs were related to incremental changes in both quality-adjusted life years (QALYs) and the Dizziness Handicap Inventory (DHI) as a disease-specific outcome; expressed as incremental cost-effectiveness ratios (ICER). Methods The study was a multicentre, cluster-randomised controlled trial with six -month follow-up. The health economic evaluation was conducted from a societal perspective. Cost-effectiveness was determined via incremental cost-utility ratios (ICURs) and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed using cost-effectiveness acceptability and net-monetary-benefit curves. Missing data were handled using Multiple Imputation by Chained Equations. Sensitivity analyses excluded informal care costs and focused on a subgroup with reduced imputation uncertainty. Results The ICER was 81,246.85€ per additional patient achieving a clinically relevant DHI improvement. Indicating that if the willingness-to-pay threshold were €50,000 per additional patient achieving a clinically relevant DHI improvement, the intervention would be cost-effective with 71% probability. The ICUR was negative (-121,847.54€/QALY), meaning optimised routine care dominated the intervention. From a payer perspective, the intervention was less costly, though with lower QALYs. Findings were robust in sensitivity analyses. Conclusion The care pathway shows potential for cost-effectiveness among patients achieving DHI improvements, supporting cautious, targeted implementation in routine care. Future research should address the economic burden on informal caregivers. Trial registration DRKS00028524 retrospectively registered on March 24, 2022.