title: Economic modelling of a public health programme for fall prevention.
abstract: BACKGROUND
  despite evidence on what works in falls prevention, falls in older people remain an important public health problem.
  
  
  OBJECTIVE
  the purpose of this study was to model the impact and cost-effectiveness of a public health falls prevention programme, from the perspective of the health funder.
  
  
  METHODS
  a decision analytic Markov model compared the health benefits in quality-adjusted life years (QALYs) and costs of treatment and residential aged care with and without a population heath falls prevention programme. Different intervention costs, uptake levels and programme effectiveness were modelled in sensitivity analyses. Uncertainty was explored using univariate and probabilistic sensitivity analysis.
  
  
  RESULTS
  widespread rollout of a public health fall prevention programme could result in an incremental cost-effectiveness ratio (ICER) of $A28,931 per QALY gained, assuming a programme cost of $700 per person and at a fall prevention risk ratio of 0.75. This ICER would be considered cost-effective at a threshold value of $A50,000 per QALY gained. Sensitivity analyses for programme cost and effectiveness indicated that the public health programme produced greater health outcomes and was less costly than no programme when programme costs were $A500 or lower and risk ratio for falls was 0.70 or lower. At a cost of $A2,500, the public health falls prevention programme ceases to be a cost-effective option.
  
  
  CONCLUSIONS
  serious consideration should be given to implementation of a public health programme of falls prevention as a cost-effective option that enables population-wide access to the intervention strategies.
authors.affiliation: Musculoskeletal Divison, The George Institute, Level 7, 341 George Street, Sydney, New South Wales, Australia.
authors.forename: Inez
authors.initials: I
authors.lastname: Farag
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Manuela L
authors.initials: ML
authors.lastname: Ferreira
authors.affiliation: Musculoskeletal Division, The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sherrington
mesh_terms: D000058:Accidental Falls / Q000191:economics / Q000517:prevention & control*; D000368:Aged; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000191:economics; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D015397:Program Evaluation; D011634:Public Health / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D012112:Residential Facilities / Q000191:economics
keywords: Markov model; ageing; falls prevention; older people