Background Some falls prevention interventions for the older population appear cost-effective, but there is uncertainty about others. Therefore, we aimed to model three types of exercise programme each running for 25 years among 65+ year olds: (i) a peer-led group-based one; (ii) a home-based one and (iii) a commercial one.
Methods An established Markov model for studying falls prevention in New Zealand (NZ) was adapted to estimate incremental cost-effectiveness ratios (ICERs) in cost per quality-adjusted life-years (QALYs) gained. Detailed NZ experimental, epidemiological and cost data were used for the base year 2011. A health system perspective was taken and a discount rate of 3% applied. Intervention effectiveness estimates came from a Cochrane Review.
Results The intervention generating the greatest health gain and costing the least was the home-based exercise programme intervention. Lifetime health gains were estimated at 47 100 QALYs (95%uncertainty interval (UI) 22 300 to 74 400). Cost-effectiveness was high (ICER: US$4640 per QALY gained; (95% UI US$996 to 10 500)), and probably more so than a home safety assessment and modification intervention using the same basic model (ICER: US$6060). The peer-led group-based exercise programme was estimated to generate 42 000 QALYs with an ICER of US$9490. The commercially provided group programme was more expensive and less cost-effective (ICER: US$34 500). Further analyses by sex, age group and ethnicity (Indigenous Māori and non-Māori) for the peer-led group-intervention showed similar health gains and cost-effectiveness.
Conclusions Implementing any of these three types of exercise programme for falls prevention in older people could produce considerable health gain, but with the home-based version being likely to be the most cost-effective.
- economic analysis
- cost-utility analysis
- equity analysis
- older people
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Contributors ED: led the literature review, model parameterisation and initial write-up. GK with assistance from ED: re-configuration of the original falls model. FP, GK, NW and TB: designed and developed the original model. NW with all authors contributing to checking and revisions: final drafting and revisions of the manuscript.
Funding This study was conducted as part of the Burden of Disease Epidemiology, Equity and Cost- Effectiveness Programme (BODE3) of the University of Otago. This programme is funded by the Health Research Council of New Zealand (grant numbers: 10/248 and 16/443) but the funder had no role in the design, conduct or reporting of the study. The modelling in this article was the basis of a Master in Public Health dissertation by ED, funded through the New Zealand College of Public Health Medicine and Health Workforce New Zealand and carried out through the University of Otago, Wellington. Funding was also done by the Ministry of Business, Innovation and Employment (MBIE), which funded related work on falls prevention (grant number: UOOX1406). Approval was granted for this dissertation by the University of Otago’s Postgraduate Academic Committee. Pega was supported via a Health Sciences Career Development Postdoctoral Fellowship.
Disclaimer Any views/conclusions in this publication are those of the authors and may not reflect the positions of the Ministry of Health, ACC or any other employers (ie, the WHO).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The authors can be contacted for additional data and this will be provided pending agreement from the agencies providing these data (the Ministry of Health and ACC).
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