title: Home safety assessment and modification to reduce injurious falls in community-dwelling older adults: cost-utility and equity analysis.
abstract: This study aimed to improve on previous modelling work to determine the health gain, cost-utility and health equity impacts from home safety assessment and modification (HSAM) for reducing injurious falls in older people.
  
  
  
  The model was a Markov macrosimulation one that estimated quality-adjusted life-years (QALYs) gained. The setting was a country with detailed epidemiological and cost data (New Zealand (NZ)) for 2011. A health system perspective was taken and a discount rate of 3% was used (for both health gain and costs). Intervention effectiveness estimates came from a Cochrane systematic review and NZ-specific intervention costs were from a randomised controlled trial.
  
  
  
  In the 65 years and above age group, the HSAM programme cost a total of US$98 million (95% uncertainty interval (UI) US$65 to US$139 million) to implement nationally and the accrued net health system costs were US$74 million (95% UI: cost saving to US$132 million). Health gains were 34 000 QALYs (95% UI: 5000 to 65 000). The incremental cost-effectiveness ratio (ICER) was US$6000 (95% UI: cost saving to US$13 000), suggesting that HSAM is highly cost-effective. Targeting HSAM only to older people with previous injurious falls and to older people aged 75 years and above were also cost-effective (ICERs=US$1000 and US$11 000, respectively). There was no evidence for differential cost-effectiveness by gender or by ethnicity (Indigenous New Zealanders: Māori vs non-Māori).
  
  
  
  As per other studies, this modelling study indicates that the provision of an HSAM intervention produces considerable health gain and is highly cost-effective among older people. Targeting this intervention to older people with previous injurious falls is a promising initial approach before any scale up.
  
  
  
  ACTRN12609000779279.
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Frank
authors.initials: F
authors.lastname: Pega
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Giorgi
authors.initials: G
authors.lastname: Kvizhinadze
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Tony
authors.initials: T
authors.lastname: Blakely
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: June
authors.initials: J
authors.lastname: Atkinson
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Nick
authors.initials: N
authors.lastname: Wilson
mesh_terms: D000058:Accidental Falls / Q000191:economics / Q000517:prevention & control*; D000061:Accidents, Home / Q000191:economics / Q000517:prevention & control*; D000368:Aged; D003362:Cost-Benefit Analysis; D004779:Environment Design / Q000191:economics; D006804:Ergonomics / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008297:Male; D008390:Markov Chains; D008962:Models, Theoretical; D009520:New Zealand / Q000453:epidemiology; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012196:Review Literature as Topic; D017751:Safety Management