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.
    Full-text · Article · May 2014 · BioMed Research International
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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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    • "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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