Economic Evaluations of Falls Prevention Programs for Older Adults: A Systematic Review

Olij, Branko F.; Ophuis, Robbin H.; Polinder, Suzanne; Beeck, Ed F. van; Burdorf, Alex; Panneman, M.J.M.; Sterke, Carolyn Shanty

doi:10.1111/jgs.15578

Cited by 33 publications

(31 citation statements)

References 54 publications

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“…Economic evaluation of cost-effectiveness of exercise-based interventions in reducing falls in older adults remains significantly limited. Although differences in study populations, intervention type, costs, delivery mode, and time frame preclude a direct comparison among programs, results of our economic analyses are consistent with those limited reports showing cost-effectiveness of exercise interventions in preventing falls among older adults (12,13,29–31) and people with Parkinson’s disease (32,33). Our findings were, however, inconsistent with the evaluation of a study that indicated a lack of strong evidence to support cost-effectiveness of a group-based exercise approach (34).…”

Section: Discussionsupporting

confidence: 82%

“…TJQMBB has been shown to be readily implementable in both community and clinical settings, with strong evidence of uptake by service providers and clinicians, resulting in effective reach into target populations, reduced falls, and excellent program fidelity and maintenance (35,39–42). The cost-effectiveness information resulting from this study and others (12,13,36) suggests that health services and fall prevention efforts globally can address the problem of older adult falls through the adoption of a low-cost, accessible, scalable intervention such as TJQMBB.…”

Section: Discussionmentioning

confidence: 79%

“…Evidence generated from randomized controlled fall prevention intervention trials has led to the consensus that exercise can reduce the risk and incidence of falls among older adults (9–11) while still being cost-effective (12,13), making it highly appropriate and relevant in clinical practice as a primary resource for the prevention of falls. However, not all proven programs are equal in their resource requirements, cost-effectiveness, or monetary savings (14,15).…”

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confidence: 99%

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Cost-Effectiveness of a Therapeutic Tai Ji Quan Fall Prevention Intervention for Older Adults at High Risk of Falling

Harmer

Eckstrom

et al. 2019

The Journals of Gerontology: Series A

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Background Data on the cost-effectiveness of proven fall prevention exercise interventions are limited. We aimed to establish the cost-effectiveness of Tai Ji Quan: Moving for Better Balance (TJQMBB) compared with a conventional exercise intervention for older adults at high risk of falling. Methods We conducted a trial-based cost-effectiveness analysis involving 670 older adults who had a history of falling or impaired mobility. Participants received one of three interventions—TJQMBB, multimodal exercise, or stretching exercise (control)—each of which was implemented twice weekly for 24 weeks. The primary cost-effectiveness measure was the incremental cost per additional fall prevented, comparing TJQMBB and multimodal exercise to Stretching and TJQMBB to multimodal exercise, with a secondary measure of incremental cost per additional quality-adjusted life-year (QALY) gained. The intervention was conducted between February 2015 and January 2018, and cost-effectiveness was estimated from a health care system perspective over a 6-month time horizon. Results The total cost to deliver the TJQMBB intervention was $202,949 (an average of $906 per participant); for multimodal exercise, it was $223,849 ($1,004 per participant); and for Stretching, it was $210,468 ($903 per participant). Incremental cost-effectiveness ratios showed that the multimodal exercise was cost-effective ($850 per additional fall prevented; $27,614 per additional QALY gained) relative to Stretching; however, TJQMBB was the most economically dominant strategy (ie, having lower cost and being clinically more efficacious) compared with multimodal and stretching exercises with regard to cost per additional fall prevented and per additional QALY gained. TJQMBB had a 100% probability of being cost-effective, relative to Stretching, at a threshold of $500 per each additional fall prevented and $10,000 per additional QALY gained. Sensitivity analyses showed the robustness of the results when extreme cases, medical costs only, and missing data were considered. Conclusions Among community-dwelling older adults at high risk for falls, TJQMBB is a cost-effective means of reducing falls compared with conventional exercise approaches. Trial Registration Clinicaltrials.gov (NCT02287740).

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 79%

mentioning

confidence: 99%

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Cost-Effectiveness of a Therapeutic Tai Ji Quan Fall Prevention Intervention for Older Adults at High Risk of Falling

Harmer

Eckstrom

et al. 2019

The Journals of Gerontology: Series A

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“…These health outcomes can result in a reduction in hospital admissions, revalidation treatments, and other related treatments, which in turn could lead to a reduction in health care costs. 66 Overall, this would be a more efficient provision of health care. Moreover, we expect that the results of this study will add valuable information to the knowledge of the systematic implementation of falls prevention for those who need a tailored treatment geared to their personal situations.…”

Section: Discussionmentioning

confidence: 99%

<p>Implementation and Evaluation of a Fall Risk Screening Strategy Among Frail Older Adults for the Primary Care Setting: A Study Protocol</p>

Meekes¹,

Leemrijse²,

Korevaar³

et al. 2020

CIA

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Background: Falls are an increasing problem among older people. There are several evidence-based interventions available to prevent falls. However, these are not always well implemented in the primary care setting. General practitioners (GPs) are often the first point of contact for health issues, making them the designated professionals for providing falls prevention. Because GPs are often unaware which patients have a high fall risk and patients themselves do not always know they have a high fall risk, this study aims to evaluate the implementation of a targeted fall risk screening strategy among independently living, frail older people in the primary care setting. Materials and Methods: The targeted fall risk screening strategy used in this study consists of tools for screening high fall risk and for identifying the underlying cause(s) of the high fall risk, an accredited training course in falls prevention for professionals, and service provision by certified physio-and exercise therapists who are able to offer evidencebased falls prevention interventions. This targeted fall risk screening strategy will be implemented in the primary care setting and evaluated at the level of the GP practice and at the level of the patient by using the RE-AIM model of Glasgow et al. In a pre-posttest design, data will be collected of the total number of frail older people who are screened, referred and enrolled for fall-preventive care. Furthermore, barriers and facilitators of the implementation of the fall risk screening strategy will be identified by conducting focus groups and interviews with the care providers and frail older patients. Additionally, the influence of the falls prevention interventions on frail older patients will be evaluated by using a pre-posttest design with a 12-month follow-up period during which data are collected regarding patients' stability, mobility, strength, balance, self-efficacy, health status, and daily activities. Study Registration: This study is approved by the Medical Ethics Committee Brabant, the Netherlands (NL61582.028.17/ P1732) and registered at the Netherlands Trial Register, NL7917.

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“…Considering the adjustments in both duration and target population of the original In Balance intervention, re-evaluation of the effectiveness of the intervention is urgently needed. Moreover, evidence on the cost-effectiveness of fall prevention programmes is scarce [ 26 ]. Cost-effectiveness analysis of the In Balance intervention would allow insurance companies, policy- and decision makers to allocate health resources efficiently.…”

Section: Introductionmentioning

confidence: 99%

The (cost-)effectiveness of an implemented fall prevention intervention on falls and fall-related injuries among community-dwelling older adults with an increased risk of falls: protocol for the in balance randomized controlled trial

et al. 2021

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Background Falls and fall-related injuries among older adults are a serious threat to the quality of life and result in high healthcare and societal costs. Despite evidence that falls can be prevented by fall prevention programmes, practical barriers may challenge the implementation of these programmes. In this study, we will investigate the effectiveness and cost-effectiveness of In Balance, a fourteen-week, low-cost group fall prevention intervention, that is widely implemented in community-dwelling older adults with an increased fall risk in the Netherlands. Moreover, we will be the first to include cost-effectiveness for this intervention. Based on previous evidence of the In Balance intervention in pre-frail older adults, we expect this intervention to be (cost-)effective after implementation-related adjustments on the target population and duration of the intervention. Methods This study is a single-blinded, multicenter randomized controlled trial. The target sample will consist of 256 community-dwelling non-frail and pre-frail adults of 65 years or older with an increased risk of falls. The intervention group receives the In Balance intervention as it is currently widely implemented in Dutch healthcare, which includes an educational component and physical exercises. The physical exercises are based on Tai Chi principles and focus on balance and strength. The control group receives general written physical activity recommendations. Primary outcomes are the number of falls and fall-related injuries over 12 months follow-up. Secondary outcomes consist of physical performance measures, physical activity, confidence, health status, quality of life, process evaluation and societal costs. Mixed model analyses will be conducted for both primary and secondary outcomes and will be stratified for non-frail and pre-frail adults. Discussion This trial will provide insight into the clinical and societal impact of an implemented Dutch fall prevention intervention and will have major benefits for older adults, society and health insurance companies. In addition, results of this study will inform healthcare professionals and policy makers about timely and (cost-)effective prevention of falls in older adults. Trial registration Netherlands Trial Register: NL9248 (registered February 13, 2021).

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Economic Evaluations of Falls Prevention Programs for Older Adults: A Systematic Review

Cited by 33 publications

References 54 publications

Cost-Effectiveness of a Therapeutic Tai Ji Quan Fall Prevention Intervention for Older Adults at High Risk of Falling

Cost-Effectiveness of a Therapeutic Tai Ji Quan Fall Prevention Intervention for Older Adults at High Risk of Falling

<p>Implementation and Evaluation of a Fall Risk Screening Strategy Among Frail Older Adults for the Primary Care Setting: A Study Protocol</p>

The (cost-)effectiveness of an implemented fall prevention intervention on falls and fall-related injuries among community-dwelling older adults with an increased risk of falls: protocol for the in balance randomized controlled trial

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