Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls.
BACKGROUND
multifactorial falls prevention programmes for older people have been proved to reduce falls. However, evidence of their cost-effectiveness is mixed.


METHODS
economic evaluation alongside pragmatic randomised controlled trial.


METHODS
randomised trial of 364 people aged ≥70, living in the community, recruited via GP and identified as high risk of falling. Both arms received a falls prevention information leaflet. The intervention arm were also offered a (day hospital) multidisciplinary falls prevention programme, including physiotherapy, occupational therapy, nurse, medical review and referral to other specialists.


METHODS
self-reported falls, as collected in 12 monthly diaries. Levels of health resource use associated with the falls prevention programme, screening (both attributed to intervention arm only) and other health-care contacts were monitored. Mean NHS costs and falls per person per year were estimated for both arms, along with the incremental cost-effectiveness ratio (ICER) and cost effectiveness acceptability curve.


RESULTS
in the base-case analysis, the mean falls programme cost was £349 per person. This, coupled with higher screening and other health-care costs, resulted in a mean incremental cost of £578 for the intervention arm. The mean falls rate was lower in the intervention arm (2.07 per person/year), compared with the control arm (2.24). The estimated ICER was £3,320 per fall averted.


CONCLUSIONS
the estimated ICER was £3,320 per fall averted. Future research should focus on adherence to the intervention and an assessment of impact on quality of life.
Irvine
Lisa
L
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
Conroy
Simon P
SP
Sach
Tracey
T
Gladman
John R F
JR
Harwood
Rowan H
RH
Kendrick
Denise
D
Coupland
Carol
C
Drummond
Avril
A
Barton
Garry
G
Masud
Tahir
T
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000368:Aged; D003362:Cost-Benefit Analysis; D003631:Day Care, Medical / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D015577:Geriatric Assessment / Q000379:methods; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D016852:Housing for the Elderly / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009788:Occupational Therapy / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D015397:Program Evaluation; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors