title: Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population.
abstract: BACKGROUND
  Falls among older people are of growing concern globally. Implementing cost-effective strategies for their prevention is of utmost importance given the ageing population and associated potential for increased costs of fall-related injury over the next decades. The purpose of this study was to undertake a cost-utility analysis and secondary cost-effectiveness analysis from a healthcare system perspective, of a group-based exercise program compared to routine care for falls prevention in an older community-dwelling population.
  
  
  METHODS
  A decision analysis using a decision tree model was based on the results of a previously published randomised controlled trial with a community-dwelling population aged over 70. Measures of falls, fall-related injuries and resource use were directly obtained from trial data and supplemented by literature-based utility measures. A sub-group analysis was performed of women only. Cost estimates are reported in 2010 British Pound Sterling (GBP).
  
  
  RESULTS
  The ICER of GBP£51,483 per QALY for the base case analysis was well above the accepted cost-effectiveness threshold of GBP£20,000 to £30,000 per QALY, but in a sensitivity analysis with minimised program implementation the incremental cost reached GBP£25,678 per QALY. The ICER value at 95% confidence in the base case analysis was GBP£99,664 per QALY and GBP£50,549 per QALY in the lower cost analysis. Males had a 44% lower injury rate if they fell, compared to females resulting in a more favourable ICER for the women only analysis. For women only the ICER was GBP£22,986 per QALY in the base case and was below the cost-effectiveness threshold for all other variations of program implementation. The ICER value at 95% confidence was GBP£48,212 in the women only base case analysis and GBP£23,645 in the lower cost analysis. The base case incremental cost per fall averted was GBP£652 (GBP£616 for women only). A threshold analysis indicates that this exercise program cannot realistically break even.
  
  
  CONCLUSIONS
  The results suggest that this exercise program is cost-effective for women only. There is no evidence to support its cost-effectiveness in a group of mixed gender unless the costs of program implementation are minimal. Conservative assumptions may have underestimated the true cost-effectiveness of the program.
authors: Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia. jessmon@aapt.net.au.|Bentleigh Bayside Community Health, PO Box 30, Bentleigh East, 3165, Victoria, Australia. jessmon@aapt.net.au.
authors: Kendra
authors: K
authors: McLean
authors: Monash Injury Research Institute, Monash University, Victoria, Australia. lesley.day@monash.edu.
authors: Lesley
authors: L
authors: Day
authors: Strategic Research Centre, Population Health, Deakin University, Victoria, Australia. adhealth@optusnet.com.au.
authors: Andrew
authors: A
authors: Dalton
mesh_terms: D000058:Accidental Falls / Q000191:economics* / Q000517:prevention & control*; D000368:Aged; D003362:Cost-Benefit Analysis / Q000379:methods; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D057187:Independent Living / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance