Economic evaluation of multiple falls prevention interventions among community-residing older adults: we know the 'value', but what about 'value for money'?

INTRODUCTION

Falls among older adults are a substantial concern, with considerable effects on health, service use and costs. Preventing falls is therefore an important goal. In our previous systematic review and network meta-analysis (NMA), several effective fall prevention interventions were identified, but their cost-effectiveness in Canada remains unknown.

METHODS

A microsimulation model was used to conduct a cost-utility analysis from a public healthcare payer perspective and a lifetime time horizon. Data sources included the previous NMA, administrative datasets and published literature. Three interventions (exercise, exercise plus vision assessment [Ex + va], and Ex + va + environmental assessment) were compared to usual care in the primary analysis; a secondary analysis assessed four additional interventions. Uncertainty was characterised in scenario analyses.

RESULTS

Ex + va had the lowest cost ($149 346, 95% confidence interval [CI] 147 985-150 706) and the highest quality-adjusted life years (QALYs) gained (7.35, 95% CI 7.34-7.37), dominating all other interventions. Differences in costs and QALYs between interventions were small (ranges: $149 346-152 691; 7.27-7.35); usual care was the costliest and least effective. Results were unchanged in the scenario analyses.

DISCUSSION: Ex + va dominated all other interventions, and all primary interventions dominated usual care. Adoption of a societal perspective may affect these conclusions, as some costs for vision care and environmental modifications are borne by patients in our setting, which were not included. Uptake of interventions that reduce falls and costs is recommended. These findings demonstrate that in Canada, multiple forms of fall prevention interventions may reduce costs and improve outcomes.