title: Cost--utility analysis of a shock-absorbing floor intervention to prevent injuries from falls in hospital wards for older people.
abstract: BACKGROUND
  hospital falls place a substantial burden on healthcare systems. There has been limited research into the use of hospital flooring as an intervention against fall-related injuries.
  
  
  OBJECTIVE
  to assess the cost-effectiveness of shock-absorbing flooring compared with standard hospital flooring in hospital wards for older people.
  
  
  METHODS
  a cost-utility analysis was undertaken drawing upon data collected in a pilot cluster randomised controlled trial and the wider literature.
  
  
  METHODS
  the trial included eight hospital sites across England. Four sites installed shock-absorbing flooring in one bay, and four maintained their standard flooring.
  
  
  METHODS
  falls and resulting injuries and treatment were reported by hospital staff. Data on destination of discharge were collected. Patients were followed up at 3 months and further resource use data were collected. Health-related quality of life was assessed, allowing quality-adjusted life years (QALYs) to be estimated. The incremental cost-effectiveness ratio of the shock-absorbing flooring was assessed compared with the standard hospital flooring.
  
  
  RESULTS
  in the base case, the shock-absorbing flooring was cost saving, but generated QALY losses due to an increase in the faller rate reported in the intervention arm. Scenario analysis showed that if the shock-absorbing flooring does not increase the faller rate it is likely to represent a dominant economic strategy-generating cost savings and QALY gains.
  
  
  CONCLUSIONS
  the shock-absorbing flooring intervention has the potential to be cost-effective but further research is required on whether the intervention flooring results in a higher faller rate than standard flooring.
authors.affiliation: Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. n.latimer@sheffield.ac.uk
authors.forename: Nicholas
authors.initials: N
authors.lastname: Latimer
authors.forename: Simon
authors.initials: S
authors.lastname: Dixon
authors.forename: Amy Kim
authors.initials: AK
authors.lastname: Drahota
authors.forename: Martin
authors.initials: M
authors.lastname: Severs
mesh_terms: D000058:Accidental Falls / Q000191:economics*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D005430:Floors and Floorcoverings / Q000191:economics*; D017721:Hospital Costs; D006757:Hospital Units / Q000191:economics*; D006801:Humans; D007297:Inpatients; D008297:Male; D018803:Models, Economic; D010865:Pilot Projects; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D014947:Wounds and Injuries / Q000175:diagnosis / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*
keywords: cost-effectiveness; falls; flooring-intervention; older people