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Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls |
Irvine L, Conroy SP, Sach T, Gladman JR, Harwood RH, Kendrick D, Coupland C, Drummond A, Barton G, Masud T |
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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 determine the cost-effectiveness of a day-hospital programme of screening for a high risk of falls and the prevention of falls in community-dwelling older people. The authors concluded that there was a lack of evidence to suggest that this programme was cost-effective. The methods seem to have been appropriate and were clearly and transparently reported. The conclusions reached by the authors appear to be sound. Type of economic evaluation Cost-effectiveness analysis Study objective The aim was to determine the cost-effectiveness of a programme, in day hospitals, of screening for a high risk of falls, and the prevention of falls, for community-dwelling older people. Interventions The two strategies were an information leaflet together with a day-hospital falls prevention programme, and only the leaflet. The programme included physiotherapy, occupational therapy, nurse, and medical reviews, and referral to other specialists. These strategies were applied to day-hospital patients at high risk of falls and the cost of screening for risk was included for the prevention programme. Methods Analytical approach:The analysis was based on a pragmatic randomised controlled trial. The authors used the perspective of the NHS and personal social services (PSS), over a one-year time horizon.
Effectiveness data:The effectiveness data were from the randomised trial of community-dwelling people aged 70 years or older. This had a one-year follow-up, and included 364 participants. For patients with missing data, the previous month's results were carried forward. The number of withdrawals was 10 in the intervention arm and nine in the control arm. For the intervention, 172 patients were analysed and 171 for control.
Monetary benefit and utility valuations:Not relevant.
Measure of benefit:The benefit was measured as the rate of self-reported falls per year.
Cost data:The participants kept monthly diaries to capture potentially relevant costs, and these were cross-checked with their medical records. The intervention costs were recorded prospectively during the trial. Missing data for staff time were imputed. The cost of screening was included for the intervention. The unit costs were presented in UK pounds sterling (£), for the year 2007 to 2008, and were from the PSS Research Unit and NHS Reference costs.
Analysis of uncertainty:Probabilistic sensitivity analysis was performed, using bootstrapping, and a cost-effectiveness acceptability curve was constructed. A scenario, with complete-case analysis, was evaluated to assess the effects of loss to follow-up. Results In the base case, the mean cost was £349 per person, for the prevention programme. This, with the screening costs and higher other health care costs, resulted in a mean incremental cost of £578 for the intervention.
The mean fall rate was lower with the intervention (2.07 per person per year), than with the control (2.24 per person per year). The estimated incremental cost-effectiveness ratio was £3,320 per fall averted.
Complete-case analysis showed similar results. The intervention was cost-effective in less than 40% of simulations, even if decision-makers were willing to pay more than £5,000 per fall averted. Authors' conclusions The authors concluded that there was a lack of evidence to suggest that targeted screening in primary care and a multifactorial falls prevention programme, in a day-hospital setting, was cost-effective. CRD commentary Interventions:The intervention was briefly described, and further details were available in another publication (Masud, et al. 2006, see 'Other Publications of Related Interest' below for bibliographic details). The comparator was appropriate for the trial.
Effectiveness/benefits:The trial that supplied the effectiveness data was described and its methods appear to have been good. There were no obvious sources of bias. The measure of benefit, the number of falls, appears to have captured the relevant outcomes.
Costs:: The authors tried to capture all the relevant costs for the perspective. The methods used to record and impute the cost data appear to have been appropriate. The authors did not specifically state that they carried forward data for all missing values, but this was done for the number of falls.
Analysis and results:The results of the base case and sensitivity analysis were appropriately presented. The authors reported three limitations to their study. These were that the health care resource use was slightly higher in the intervention arm; the perspective was that of the NHS, rather than social care or the patient; and the results were only relevant to decisions on how to best allocate a specific falls-prevention budget.
Concluding remarks:The methods seem to have been appropriate and were clearly and transparently reported. The conclusions reached by the authors appear to be sound. Funding Funding received from the Nottinghamshire, Derbyshire and Lincolnshire research alliance, Research into Ageing, the British Geriatrics Society, and Nottingham University Hospitals NHS trust, UK. Bibliographic details Irvine L, Conroy SP, Sach T, Gladman JR, Harwood RH, Kendrick D, Coupland C, Drummond A, Barton G, Masud T. Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls. Age and Ageing 2010; 39(6): 710-716 Other publications of related interest Masud T, Coupland C, Drummond A, et al. Multifactorial day hospital intervention to reduce falls in high risk older people in primary care: a multi-centre randomised controlled trial [ISRCTN46584556]. Trials 2006; 7(1):5. Indexing Status Subject indexing assigned by NLM MeSH Accidental Falls /prevention & Aged; Cost-Benefit Analysis; Day Care, Medical /economics /organization & Geriatric Assessment /methods; Health Services /economics /statistics & Hospital Costs /statistics & Housing for the Elderly /statistics & Humans; Mass Screening /methods; Occupational Therapy /economics /organization & Patient Care Team /economics /organization & Physical Therapy Modalities /economics /organization & Program Evaluation; Residence Characteristics /statistics & Risk Factors; administration /statistics & administration /statistics & administration /statistics & administration /statistics & control /statistics & numerical data; numerical data; numerical data; numerical data; numerical data; numerical data; numerical data; numerical data; numerical data /utilization AccessionNumber 22010002011 Date bibliographic record published 02/02/2011 Date abstract record published 31/08/2011 |
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