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Economic analysis of a community-based falls prevention program |
Beard J, Rowell D, Scott D, van Beurden E, Barnett L, Hughes K, Newman B |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary The objective was to carry out an economic evaluation of a community-based fall prevention programme, namely Stay on Your Feet, which targeted older people at all levels of risk. The authors concluded that the programme was a cost-effective strategy. The study had some methodological limitations especially in the determination of the benefit measure. Overall, the authors’ conclusions appear to be valid given the accurate cost analysis. Type of economic evaluation Study objective The objective was to carry out an economic evaluation of a community-based fall prevention programme targeted at people aged 60 years or older. Interventions The preventive programme was Stay on Your Feet (SOYF), which targeted older people at all levels of risk and living independently. The programme was a multi-strategic, community-based intervention. This was compared against the current pattern of care, which did not include specific fall prevention activities. Methods Analytical approach:This economic evaluation was based on data from the programme implementation. The time horizon was not clearly stated. The perspective was not explicitly stated, but it appears that they were those of the state government, Australian government, and Australian society.
Effectiveness data:The data for the SOYF programme were derived from the prospective analysis of the programme implementation which took place between 1992 and 1996 in a region of New South Wales (NSW). A representative sample of 2,000 older people in the intervention region was compared with a similar control community in the state of Queensland (1,600 older people), and also with data from NSW as a whole. The rate of falls resulting in hospitalisation appears to have been the key endpoint.
Monetary benefit and utility valuations:Pain, suffering, and time lost due to illness, were incorporated in the derivation of benefits, as described below.
Measure of benefit:Disability-adjusted life-years (DALYs) were the summary benefit measure. The monetary value of DALYs lost due to falls was calculated using an approach adopted by the NSW Injury Risk Management Research Centre. The value of a DALY lost due to falls was calculated as a proportion (34.5%) of the total costs of falls for people over the age of 65 years.
Cost data:The economic analysis included all the financial costs associated with running the SOYF programme (excluding the evaluation costs, but including both a proportion of overhead costs and a small percentage of the fees charged to the community for exercise class attendance), and the direct costs associated with medical treatment (in-patient services, medical services, use of pharmaceutical products, nursing home services, and allied health services). The costs of the SOYF programme came from published and unpublished data provided by the programme managers. In-patient costs came from official state accounting systems and other direct medical costs were from a previous report. All costs were in Australian dollars (AUD) and referred to the financial year 1995 to 1996.
Analysis of uncertainty:Standardised cost ratios were calculated together with confidence intervals. Results From the perspective of the state government, including only the programme and hospitalisation costs, the net present value, which was the benefits minus the costs, ranged from AUD 5,402,701 (benefit to cost ratio 7.9:1) to AUD 6,325,874 (9.1:1) depending on the accounting system adopted and the comparator considered.
From the perspective of the Australian government, which also included nursing home admissions and general practice attendances, the NPV ranged from AUD 9,241,720 (12.8:1) to AUD 10,737,948 (14.7:1).
From the perspective of Australian society, which further included an evaluation of DALYs lost, the NPV ranged from AUD 14,615,265 (19.1:1) to AUD 16,917,156 (22:1).
In general, the cost of the programme was always more than offset by the reduction in direct costs related to falls regardless of the perspective taken. From the societal perspective there was an advantage in monetary benefits for DALYs due to the reduced number of falls. Authors' conclusions The authors concluded that the intervention was a cost-effective strategy for preventing falls in older people. CRD commentary Interventions:Details of the SOYF programme were published elsewhere and little information on the intervention was given in this paper. The comparator was the current pattern of care in the authors’ country. Thus, the selection of the comparators was appropriate, but more information on the intervention would have been useful.
Effectiveness/benefits:The clinical analysis was based on a published report, which was not described. It was a population-based analysis, but details of the patient sample, modalities of intervention delivery, follow-up, and other methodological characteristics were not reported, which makes it difficult to judge the validity of the clinical estimates. The derivation of the benefit measure was based on the assumption reported in another publication that assigned a monetary value to DALYs based on a percentage of the total costs. This approach was not described and might not be robust. It would have been helpful to have addressed this issue in a specific sensitivity analysis.
Costs:Three perspectives appear to have been used: that of the state government that funded the intervention, that of the Australian government, and that of Australian society. The costs were presented as macro-categories and were not broken down into individual items. Some of these costs were derived from publications, whose accounting systems were not reported. These issues may have introduced uncertainty into the cost analysis. The authors acknowledged that some cost categories could not be taken into account due to the lack of reliable data. In general, a justification was provided for these exclusions. The details of the cost calculations, especially for hospitalisation costs, were extensively presented. The use of a discount rate to adjust the costs to a common price year was reported. Statistical analyses were performed on the cost estimates. Two general approaches were used to calculate the costs and the results were presented for both methods as well as for the combined approach.
Analysis and results:The results were presented for all scenarios, but in an aggregate fashion. The use of the NPV was appropriate for the cost-benefit framework. The issue of uncertainty was not extensively investigated and no systematic approach was used, except for the analysis of costs. The authors stated that other studies had produced similar results.
Concluding remarks:The study had some methodological limitations especially in the determination of the benefit measure. Overall, the authors’ conclusions appear to be valid given the accurate cost analysis. Funding Supported by funding from the Australian National Health and Medical Research Council, and NSW Health. Bibliographic details Beard J, Rowell D, Scott D, van Beurden E, Barnett L, Hughes K, Newman B. Economic analysis of a community-based falls prevention program. Public Health 2006; 120(8): 742-751 Other publications of related interest Garner E, Kempton A, van Beurden E. Strategies to prevent falls: the Stay on Your Feet program. Health Promotion Journal of Australia 1996; 6: 36-43.
Smith RD, Widiatmoko D. The cost-effectiveness of home assessment and modification to reduce falls in the elderly. Australia and New Zealand Journal of Public Health 1998; 22: 436-440.
Robertson MC, Devlin N, Scuffham P, Gardner MM, Buchner DM, Campbell JA. Economic evaluation of a community based exercise programme to prevent falls. Journal of Epidemiology and Community Health 2001; 55: 600-606. Indexing Status Subject indexing assigned by NLM MeSH Accidental Falls /prevention & Aged; Community Health Services /economics; Cost-Benefit Analysis; Health Promotion /economics /methods; Hospitalization /economics; Humans; control AccessionNumber 22006001583 Date bibliographic record published 21/08/2006 Date abstract record published 13/01/2010 |
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