ArticleAge and ageing2025
Efficiency and equity of community-based falls prevention pathways: a model-based health economic evaluation.
Article in Age and ageing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThree 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.
methodsCost-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.
resultsPublic 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.
conclusionsBoth 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.
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