Does a home based strength and balance programme in people aged ≥ 80 years provide the best value for money to prevent falls?: A systematic review of economic analyses of falls prevention interventions
- M Clare Robertson (clare.robertson{at}stonebow.otago.ac.nz)
Abstract
Objectives: To investigate the value for money of strategies to prevent falls in older adults living in the community.
Design: Systematic review of peer reviewed journal articles reporting an economic evaluation of a falls prevention intervention as part of a randomised controlled trial, a controlled trial, or using an analytic model. We searched MEDLINE, PUBMED, EMBASE, and NHS EED databases to identify cost effectiveness, cost utility, and cost benefit studies from 1945 through July 2008.
Setting: Not applicable.
Patients: Not applicable.
Intervention: Not applicable.
Main outcome measures: Our primary outcome measure was incremental cost-effectiveness, cost-utility and cost-benefit ratios in the reported currency and in pounds sterling at 2008 prices. We assessed the quality of the studies using two instruments: 1) an economic evaluation checklist developed by Drummond and colleagues and 2) the Quality of Health Economic Studies instrument.
Results: Nine studies meeting our inclusion criteria included eight cost-effectiveness analyses, one cost-utility and one cost-benefit analysis. Three effective falls prevention strategies were cost saving in a subgroup of participants: (i) an individually customised multifactorial programme in those with four or more of the eight targeted fall risk factors, (ii) the home based Otago Exercise Programme in people ≥80 years, and (iii) a home safety programme in the subgroup with a previous fall. These three findings were from six studies that scored ≥75% on the Quality of Health Economic Studies instrument.
Conclusions: Best value for money came from effective single factor interventions such as the Otago Exercise Programme which was cost saving in adults 80 years and older. This programme has broad applicability and therefore warrants health policy decision makers' close scrutiny.
