An economic evaluation of community and residential aged care falls prevention strategies in NSW
Key Objective:
To assess the costs and benefits of falls prevention strategies in the older people living in NSW in both the community and residential aged care
In New South Wales, no other single cause of injury (including road trauma), costs the health care system more than fall-related injury (NSW Department of Health, 2006). In addition to the direct economic costs, falls also reduce independence and confidence, cause increased anxiety / depression and reduce health related quality of life. The costs associated with falls are expected to escalate over the next 20 years unless effective prevention programs are implemented and these costs are predicted to rise to 2.7 times those in 2001 by 2051 (Hendrie, et al., 2004, Moller, 2003). This project aims to evaluate the cost-effectiveness of interventions that help reduce the risk of falling and furthermore, the associated morbidity and mortality that result from falling.
The first part of the analysis involved conducting a meta-analysis exploring interventions for preventing falls, in both the community and residential care. Only interventions with robust positive results were then analysed on a cost-effectiveness basis. The second part of the analysis involved designing a Markov decision-analytical model to simulate the impact of interventions on the elderly population in NSW. The benefits associated with the varied interventions were measured by falls avoided, injuries avoided and hospitalisations avoided. Cost-effectiveness was measured in terms of the incremental cost per life year gained and cost per QALY (quality adjusted life year). The model parameters were tested by sensitivity analysis.
The results show that in community-dwelling older people, the most cost-effective interventions are expedited cataract surgery, psychotropic medication withdrawal, Tai Chi, home hazard Assessment and group-based exercise. In the residential aged care setting, the most cost-effective interventions are medication review, hip protectors and vitamin D supplementation. The economic model was sensitive to a number of model inputs; in particular the key driver appeared to be the quality of life decrement associated with a fear of falling. The model was also sensitive to the effectiveness and cost of each intervention, however there is more certainty regarding those estimates.
This work has resulted in the publication of twopeer reviewed articles:
Church, J., Goodall, S., Norman, R.P. & Haas, M.R. 2011, 'An economic evaluation of community and residential aged care falls prevention strategies in NSW', NSW Public Health Bulletin, vol. 22, no. 3-4, pp. 60-68.
Church, J., Goodall, S., Norman, R.P. & Haas, M.R. 2011, 'Falls prevention interventions for older community-dwelling Australians are cost-effective', Australian and New Zealand Journal of Public Health, vol. in press.
Funding source
CHEEP – NSW Health and Cancer Institute
CHERE staff
Jody Church, Richard Norman, Stephen Goodall, Marion Haas
Collaborators
NSW Department of Health
