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Home safety assessment and modification to reduce injurious falls in community-dwelling older adults: cost-utility and equity analysis
  1. Frank Pega,
  2. Giorgi Kvizhinadze,
  3. Tony Blakely,
  4. June Atkinson,
  5. Nick Wilson
  1. Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
  1. Correspondence to Dr Frank Pega, Department of Public Health, University of Otago, 23a Mein Street, Newtown, Wellington 6242, New Zealand; frank.pega{at}


Background 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.

Methods 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.

Results 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).

Conclusions 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.

Trial registration number ACTRN12609000779279.

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  • Contributors FP lead the overall study design and development. GK lead and all other authors contributed to model development. FP lead and all authors contributed to the interpretation of findings and the development of the manuscript.

  • Funding This study was conducted as part of the BODE3 of the University of Otago. This programme is primarily funded by the Health Research Council of New Zealand (grant no: 10/248). This study was funded through this programme and also the University of Otago via a Health Sciences Career Development Postdoctoral Fellowship to Pega. No financial disclosures were reported by the authors of this paper.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.