Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls

Abstract

Background: multifactorial falls prevention programmes for older people have been proved to reduce falls. However, evidence of their cost-effectiveness is mixed.Design: economic evaluation alongside pragmatic randomised controlled trial.Intervention: randomised trial of 364 people aged ≥70, living in the community, recruited via GP and identified as high risk of falling. Both arms received a falls prevention information leaflet. The intervention arm were also offered a (day hospital) multidisciplinary falls prevention programme, including physiotherapy, occupational therapy, nurse, medical review and referral to other specialists.Measurements: self-reported falls, as collected in 12 monthly diaries. Levels of health resource use associated with the falls prevention programme, screening (both attributed to intervention arm only) and other health-care contacts were monitored. Mean NHS costs and falls per person per year were estimated for both arms, along with the incremental cost-effectiveness ratio (ICER) and cost effectiveness acceptability curve.Results: in the base-case analysis, the mean falls programme cost was £349 per person. This, coupled with higher screening and other health-care costs, resulted in a mean incremental cost of £578 for the intervention arm. The mean falls rate was lower in the intervention arm (2.07 per person/year), compared with the control arm (2.24). The estimated ICER was £3,320 per fall averted.Conclusions: the estimated ICER was £3,320 per fall averted. Future research should focus on adherence to the intervention and an assessment of impact on quality of life.

Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization

“…26 Several studies have used quality of life as an outcome measure, 27e29 and many more studies have considered costeffectiveness in terms of the cost per fall prevented. 12,13,28,30,31 There is wide variation in the results of the incremental cost per fall prevented, with the range spanning from $A294 (2008) 32 to $NZ1803 (1998). 33 The variation in the values presented is reflective of heterogeneity between studies, with differences in the health care systems between countries, in the study perspective, which in turn influences the cost consideration and in the type of program intervention.…”

“…Economic evaluations conducted in association with randomized controlled trials 12,13 and modeled studies 14,15 indicate potential for cost savings and considerable benefits of fall prevention programs conducted in the general community. To date, however, no economic evaluations have been published examining the cost-effectiveness of a home-exercise program for older people recently discharged from hospital.…”

“…To date, however, no economic evaluations have been published examining the cost-effectiveness of a home-exercise program for older people recently discharged from hospital. Further research is also required to assess the impact of fall prevention programs on quality of life 12 ; enabling comparison with other health care programs available to older people.…”

Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users� Willingness to Pay: Web-Based Survey Among Older Adults (Preprint)

“…Nevertheless, to the best of our knowledge, we are the first researchers being able to price a fall prevention smartphone application and therefore are able to support developers in designing an application satisfying users' expectations. Prior studies primarily investigated the clinical costs of fall patients as well as the amount of money saved by different intervention programs [38,39]. By our results researchers as well as practitioners get an idea which product features are necessary to design a smartphone application which will be accepted by potential users and how much money they could charge for such an application.…”

The Impact of Outliers on Net-Benefit Regression Model in Cost-Effectiveness Analysis

“…The conventional strategy to deal with outliers is to estimate incremental cost-effectiveness ratio (ICER) by including and excluding outliers in order to see how they impact ICER [20]–[24]. In those studies, the estimates of ICER when including outliers were larger than those when excluding them.…”