Evaluating the Cost-Effectiveness of Fall Prevention Programs that Reduce Fall-Related Hip Fractures in Older Adults

Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 01/2010; 58(1):136-41. DOI: 10.1111/j.1532-5415.2009.02575.x
Source: PubMed


To model the incremental cost-utility of seven interventions reported as effective for preventing falls in older adults.
Mathematical epidemiological model populated by data based on direct clinical experience and a critical review of the literature.
Model represents population level interventions.
No human subjects were involved in the study. MEASUREMENS: The last Cochrane database review and meta-analyses of randomized controlled trials categorized effective fall-prevention interventions into seven groups: medical management (withdrawal) of psychotropics, group tai chi, vitamin D supplementation, muscle and balance exercises, home modifications, multifactorial individualized programs for all elderly people, and multifactorial individualized treatments for high-risk frail elderly people. Fall-related hip fracture incidence was obtained from the literature. Salary figures for health professionals were based on Bureau of Labor Statistics data. Using an integrated healthcare system perspective, healthcare costs were estimated based on practice and studies on falls in older adults. Base case incremental cost utility ratios were calculated, and probabilistic sensitivity analyses were conducted.
Medical management of psychotropics and group tai chi were the least-costly, most-effective options, but they were also the least studied. Excluding these interventions, the least-expensive, most-effective options are vitamin D supplementation and home modifications. Vitamin D supplementation costs less than home modifications, but home modifications cost only $14,794/quality-adjusted life year (QALY) gained more than vitamin D. In probabilistic sensitivity analyses excluding management of psychotropics and tai chi, home modification is most likely to have the highest economic benefit when QALYs are valued at $50,000 or $100,000.
Of single interventions studied, management of psychotropics and tai chi reduces costs the most. Of more-studied interventions, home modifications provide the best value. These results must be interpreted in the context of the multifactorial nature of falls.

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    • "It has also been shown that increasing physical activity through exercise interventions that include strength and balance training can prevent falls [3, 16, 17]. However, fall-prevention programs that focus on strength and balance training have poor cost-effectiveness [18]. Since 2006, many municipalities in Japan have spent large amounts of money on fall-prevention programs using high-risk approaches intended for early identification of high-risk individuals. "
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    ABSTRACT: Objective: Promoting participation in sport organizations may be a population strategy for preventing falls in older people. In this study, we examined whether participation in sport organizations is associated with fewer falls in older people even after adjusting for multiple individual and environmental factors. Methods: We used the Japan Gerontological Evaluation Study data of 90,610 people (31 municipalities) who were not eligible for public long-term care. Logistic regression analysis was performed, with multiple falls over the past year as the dependent variable and participation in a sport organization as the independent variable, controlling for 13 factors. These included individual factors related to falls, such as age and sex, and environmental factors such as population density of the habitable area. Results: A total of 6,391 subjects (7.1%) had a history of multiple falls. Despite controlling for 13 variables, those who participated in a sport organization at least once a week were approximately ≥ 20% less likely to fall than those who did not participate at all (once a week; odds ratio = 0.82 and 95% confidence interval = 0.72-0.95). Conclusion: Participation in a sport organization at least once per week might help prevent falls in the community-dwelling older people.
    BioMed Research International 05/2014; 2014:537614. DOI:10.1155/2014/537614 · 1.58 Impact Factor
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    • "These figures have increased in recent years, in particular in the leisure sector [11]. Particularly in the elderly population, falls are associated with increasing costs, due to the greater morbidity in this population [1, 9]. As a consequence, the initiation of fall prevention programs is of high priority [1, 8]. "
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    ABSTRACT: Principals: Throughout the world, falls are a major public health problem and a socioeconomic burden. Nevertheless there is little knowledge about how the injury types may be related to the aetiology and setting of the fall, especially in the elderly. We have therefore analysed all patients presenting with a fall to our Emergency Department (ED) over the past five years. Methods: Our retrospective data analysis comprised adult patients admitted to our Emergency Department between January 1, 2006, and December 31, 2010, in relation to a fall. Results: Of a total of 6357 patients 78% (n = 4957) patients were younger than 75 years. The main setting for falls was patients home (n = 2239, 35.3%). In contrast to the younger patients, the older population was predominantly female (56.3% versus 38.6%; P < 0.0001). Older patients were more likely to fall at home and suffer from medical conditions (all P < 0.0001). Injuries to the head (P < 0.0001) and to the lower extremity (P < 0.019) occurred predominantly in the older population. Age was the sole predictor for recurrent falls (OR 1.2, P < 0.0001). Conclusion: Falls at home are the main class of falls for all age groups, particularly in the elderly. Fall prevention strategies must therefore target activities of daily living. Even though falls related to sports mostly take place in the younger cohort, a significant percentage of elderly patients present with falls related to sporting activity. Falls due to medical conditions were most likely to result in mild traumatic brain injury.
    The Scientific World Journal 03/2014; 2014:256519. DOI:10.1155/2014/256519 · 1.73 Impact Factor
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    • "Similarly, in regard to mortality registers, it would be convenient to code both the injury causing death, as well as the external cause which produced it. Given the magnitude of the burden of disease which these injuries represent, there is an urgent need to implement interventions of recognised effectiveness in order to prevent severe forms such as TSCI and TBI resulting from falls (Frick et al., 2010). Moreover, despite the good results obtained in recent years, road safety policies must be intensified with the aim of reducing the, still high, incidence rate of severe injuries among motor-vehicle users, cyclists and pedestrians, in line with the UN General Assembly resolution proclaiming a Decade of Action for Road Safety 2011–2020 (United Nations, 2011). "
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    ABSTRACT: The aim of the present study was to estimate the incidence of hospital discharges for traumatic spinal cord injury (TSCI) and traumatic brain injury (TBI) in Spain by injury circumstances (traffic crashes and others), injury severity, gender and age group and to describe its trends over the period 2000-2009. It is a study of trends that includes hospital discharges with a primary diagnosis of TSCI or TBI. Crude and age-standardised rates were calculated per million inhabitants. Changes in rates between 2000 and 2009 were assessed through calculation of the relative risk adjusted for age, using Poisson regression. Between 2000 and 2009 in Spain, 10,274 patients were admitted for traumatic TSCI, and 206,503 for TBI. The annual incidence rate for TSCI was 23.5 per million, that for TBI was 472.6 per million. The overall incidence rate for TSCI fell significantly between 2000 and 2009 by 24.2% (traffic-related 40.9%, other 12.9%), as did that for TBI (23.8% overall, 60.2% traffic-related, with no change for other circumstances). Among people aged 65 years and over, no change was observed for TSCI, incidence of TBI fell significantly when due to traffic crashes, but there was a dramatic increase of 87% in men and 89.3% in women when due to other circumstances. Over the last decade the incidence of these types of injury has fallen significantly when the injury resulted from traffic crashes, and to a lesser extent when from other circumstances. However TBI incidence among people aged 65 and over injured in non-traffic-related circumstances has risen dramatically.
    Accident; analysis and prevention 05/2012; 46:37-44. DOI:10.1016/j.aap.2011.12.004 · 1.65 Impact Factor
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