ArticleInjury epidemiology2025
Optimizing age-based targeting in ice cleat distribution programs for preventing winter fall injuries: a cost-effectiveness modeling study.
Article in Injury epidemiology, 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
backgroundFall injuries on ice and snow are a major public health problem in cold climates, placing a substantial seasonal burden on healthcare systems and affected individuals. To prevent such injuries, many Swedish municipalities have implemented programs that distribute ice cleats, typically restricted to adults aged ≥ 65. Evidence suggests these programs increase cleat use, reduce injuries, and are cost-effective. However, it remains unclear whether restricting distribution to older adults is more effective than broader or universal strategies. This study is the first to formally evaluate this question.
methodsWe developed a cohort simulation model combining elements of the local average treatment effects framework and the health belief model to evaluate the cost-effectiveness of alternative ice cleat distribution strategies across age thresholds. The model incorporates age-specific injury risks, compliance, costs, and quality-adjusted life year losses, using input from behavioral surveys, register data on ice-related fall injuries, and published literature. It is calibrated to outcomes from real-world distribution programs. Cost-effectiveness was assessed from a societal perspective, defining optimal thresholds as those maximizing net monetary benefit and acceptable thresholds as those with > 50% probability of being cost-effective compared to no distribution in probabilistic sensitivity analyses.
resultsOur primary analysis identified ≥ 55 years as the optimal eligibility threshold (acceptable range: 42-72). Sensitivity analyses indicated that universal distribution may be acceptable if cleats are purchased restrictively and targeted to non-users, but it is unlikely to be optimal. When assuming short-lived behavior change (≤ 2 years) or valuing costs from a healthcare perspective only, no distribution was preferable.
conclusionAge-targeted ice cleat distribution appears more cost-effective than universal provision and preferable to no distribution, but current programs limited to older adults may be suboptimal. Extending eligibility to middle-aged adults could further improve cost-effectiveness from a societal perspective.
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