Age and ageing · 2026
Cost-effectiveness of an integrated falls prevention programme in primary healthcare for older people in rural China: an economic evaluation alongside the FAMILY trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Wei Ting, Peng Junyi, Ye Pengpeng, Yan Shichun, Li Zhifang, Li Qian, Meng Ruilin, Li Yangchun, Hao Tianyou, Zhang Lan, Peng Dandan, Nan Boya, Xu Zijian, Chen Yuxin, Wang Ninie Y, Yang Minghui, Yao Yao, Zhang Jing, Xu Lizheng, Chen Mingsheng, Kolt Gregory S, Jan Stephen, Tian Wei, Ivers Rebecca, Wang Yongchen, Tian Maoyi, Si Lei
Аннотация
BACKGROUND: Falls and fall-related injuries are the leading cause of morbidity and mortality for older adults. For China's rapidly ageing population, the need for cost-effective falls prevention programmes is critical. FAMILY, a 12-month cluster randomised controlled trial in rural China (2610 community-dwelling older adults), demonstrated that a primary healthcare-integrated balance and functional exercise fall prevention programme reduced falls. This study assessed its cost-effectiveness.
METHODS: A within-trial economic evaluation was conducted from a healthcare system perspective. Incremental cost and effectiveness (falls prevented and quality-adjusted life-years [QALYs]) were estimated using mixed-effects regression models accounting for clustering. Costs included healthcare resource use and intervention delivery. QALYs were derived from EuroQol 5-Dimension 5-level (EQ-5D-5L) instrument administered during the trial. Uncertainty was assessed using one-way and probabilistic sensitivity analyses with two-stage bootstrapping.
RESULTS: During a mean follow-up of 358 days, the intervention was dominant, with lower costs and greater effectiveness. The intervention reduced the absolute risk of falls by 8.6% and increased QALYs by 0.024 per person. Mean cost savings of ¥293 (95% CI: -¥145 to ¥727) were observed in the intervention group. This difference was mainly driven by lower healthcare utilisation costs (¥1517 vs ¥1831), which more than offset the intervention cost of ¥20 per participant. The probability of the intervention being cost-saving was 90%, and the probability of being cost-effective was 96%.
CONCLUSIONS: A primary healthcare-integrated, falls prevention programme in rural China can improve health outcomes in older adults whilst reducing costs, providing a scalable solution for resource-constrained settings.
METHODS: A within-trial economic evaluation was conducted from a healthcare system perspective. Incremental cost and effectiveness (falls prevented and quality-adjusted life-years [QALYs]) were estimated using mixed-effects regression models accounting for clustering. Costs included healthcare resource use and intervention delivery. QALYs were derived from EuroQol 5-Dimension 5-level (EQ-5D-5L) instrument administered during the trial. Uncertainty was assessed using one-way and probabilistic sensitivity analyses with two-stage bootstrapping.
RESULTS: During a mean follow-up of 358 days, the intervention was dominant, with lower costs and greater effectiveness. The intervention reduced the absolute risk of falls by 8.6% and increased QALYs by 0.024 per person. Mean cost savings of ¥293 (95% CI: -¥145 to ¥727) were observed in the intervention group. This difference was mainly driven by lower healthcare utilisation costs (¥1517 vs ¥1831), which more than offset the intervention cost of ¥20 per participant. The probability of the intervention being cost-saving was 90%, and the probability of being cost-effective was 96%.
CONCLUSIONS: A primary healthcare-integrated, falls prevention programme in rural China can improve health outcomes in older adults whilst reducing costs, providing a scalable solution for resource-constrained settings.