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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 evaluations of falls prevention interventions
  1. J C Davis1,
  2. M C Robertson2,
  3. M C Ashe1,
  4. T Liu-Ambrose1,
  5. K M Khan1,
  6. C A Marra3
  1. 1Centre for Hip Health & Mobility, University of British Columbia & Vancouver Coastal Health Research Institute (VCHRI), Vancouver, Canada
  2. 2Department of Medical & Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  3. 3Collaboration for Outcomes Research and Evaluation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada
  1. Jennifer C Davis, 301-2647 Willow Street, Vancouver, British Columbia, Canada, V5Z 3P1; jcdavis{at}


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 or a controlled trial, or using an analytical model. MEDLINE, PUBMED, EMBASE and NHS EED databases were searched to identify cost-effectiveness, cost–utility and cost–benefit studies from 1945 through July 2008.

Main outcome measures The primary outcome measure was incremental cost-effectiveness, cost–utility and cost–benefit ratios in the reported currency and in pounds sterling at 2008 prices. The quality of the studies was assessed 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: (1) an individually customised multifactorial programme in those with four or more of the eight targeted fall risk factors, (2) the home-based Otago Exercise Programme in people ≥80 years and (3) 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 thus warranting warrants health policy decision-makers’ close scrutiny.

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  • Funding Centre for Hip Health and Mobility, Michael Smith Foundation for Health Research and the Canadian Institute for Health Research. CAM is funded by a Canada Research Chair in Pharmaceutical Outcomes and a Michael Smith Foundation for Health Research Scholar Award. MCA and TLA are funded by a Michael Smith Foundation for Health Research Scholar Award. JCD is funded by a Michael Smith Foundation for Health Research Senior Graduate Studentship and a Canadian Institute for Health Research Canada Graduate Scholarship.

  • Competing interests AJ Campbell, MCR and colleagues developed the Otago Exercise Programme and authored the studies cited in this systematic review. KMK and TL-A have published a paper where they have tested the Otago Exercise Programme in Canada. JCD is currently testing the cost-effectiveness of the Otago Exercise Programme in Canada. KMK has received funding from various drug companies to be on a speaker panel and to undertake research.

    JCD was principal investigator, was responsible for design, quality assessment, literature search, collation and summary of papers, retrieval of articles, review of studies and writing the manuscript, and is guarantor. MCR, MCA, TLA, KMK and CAM were also responsible for design, quality assessment, review of studies and writing the manuscript. MCA, JCD and MCR were responsible for quality assessment.

  • Provenance and Peer review not commissioned; externally peer reviewed