Systematic review and critical methodological appraisal of community-based falls prevention economic models

Kwon, J; Squires, H; Franklin, M; Young, T

Journal article

Systematic review and critical methodological appraisal of community-based falls prevention economic models

Abstract:: Background Three pathways exist for community-based falls prevention: reactive (R), after a fall requiring medical attention; proactive (P), after professional referral of high-risk individuals; and self-referred (SR), voluntary intervention enrolment. The UK guidelines recommend scale-up of all three [‘recommended care’ (RC)], but scale-up of none [‘usual care’ (UC)], one (R, P, SR) or two (R+P, R+SR, P+SR) are potential options. This study aims to compare the options in terms of efficiency and equity. Methods Cost-utility analysis from the societal perspective over a 40-year horizon identified the optimal strategy based on efficiency alone. Probabilistic sensitivity analysis accounted for parameter uncertainty. Efficiency and equity were jointly evaluated by distributional cost-effectiveness analysis. Alternative scenarios assessed changes in frailty, cognitive impairment, intervention demand and GP access. Results Public sector cost-effectiveness threshold would need to exceed £30 000 per quality-adjusted life year (QALY) gained for RC to have the highest probability of being cost-effective. R and R+SR were cost-effective, with costs per QALY gained of £2365 (R versus UC) and £5516 (R+SR versus R). RC was cost-ineffective, incurring £34 258 per QALY gained versus R+SR. Other strategies were dominated. However, if decision-makers had the same relative health inequality aversion level as the English general public, RC was optimal in terms of efficiency and equity at threshold of £30 000 per QALY gained. Scenarios of worse geriatric health favoured RC. Conclusions Both efficiency and relative health inequality need to be considered for the UK guideline-recommended falls prevention to be optimal versus other permutations of community-based strategies

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Kwon, J., Squires, H., Franklin, M., & Young, T. (2022). Systematic review and critical methodological appraisal of community-based falls prevention economic models. Cost Effectiveness and Resource Allocation, 20(1), 33–33.

MLA Style

Kwon, J, et al. “Systematic Review and Critical Methodological Appraisal of Community-Based Falls Prevention Economic Models.” Cost Effectiveness and Resource Allocation, vol. 20, no. 1, 2022, pp. 33–33.

Chicago Style

Kwon, J, H Squires, M Franklin, and T Young. 2022. “Systematic Review and Critical Methodological Appraisal of Community-Based Falls Prevention Economic Models.” Cost Effectiveness and Resource Allocation 20 (1): 33–33.
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