Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-26T03:24:52.591Z Has data issue: false hasContentIssue false
  • English
  • Français

How Much Are We Willing to Pay to Prevent A Fall? Cost-Effectiveness of a Multifactorial Falls Prevention Program for Community-Dwelling Older Adults*

Published online by Cambridge University Press:  24 May 2012

Krista Bray Jenkyn ,
Jeffrey S. Hoch  and
Mark Speechley
Krista Bray Jenkyn*
Affiliation:
Lawson Health Research Institute, St. Joseph’s Health Care
Jeffrey S. Hoch
Affiliation:
Centre for Research on Inner City Health, St. Michael’s Hospital
Mark Speechley
Affiliation:
Department of Epidemiology & Biostatics, Schulich School of Medicine and Dentistry, Western University
*
†Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: K. Bray Jenkyn, Ph.D. Lawson Health Research Institute St. Joseph’s Health Care, Parkwood Hospital 801 Commissioners Rd. East London, Ontario N6C 5J1 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

This study examined the cost-effectiveness of a multifactorial falls prevention program and estimated the trade-off between the extra costs of such a program and the additional reduction of unintentional falls. Cost-effectiveness was evaluated using the traditional incremental cost-effectiveness ratio (ICER) and the net benefit regression framework (NBRF). Using the NBRF, decision making was formalized by incorporating values of willingness to pay (WTP) a priori. The results failed to provide evidence that a multifactorial falls prevention program was cost-effective. Participant adherence to recommendations ranged from low (41.3%), to moderate (21.1%), to high (37.6%). A future challenge is to understand more clearly the relationship between the community-dwelling older adult, potentially modifiable risks for falls, adherence to multifactorial risk factor recommendations, costs, and resulting effects of falls prevention practices. Future economic evaluations of falls prevention interventions remain necessary and should consider the NBRF so that regression tools can facilitate cost-effectiveness analysis.

Résumé

Cette étude a examiné le rapport coût-efficacité d’un programme multifactoriel de prévention des chutes et a évalué le compromis entre les coûts supplémentaires d’un tel programme et une augmentation de la réduction des chutes accidentelles. Le rapport coût-efficacité a été évalué en utilisant le rapport coût-efficacité différentiel traditionnel (RCED) et cadre de régression de l’avantage net (CRAN). En utilisant du CRAN, la prise de décision a été officialisée par l’incorporation, a priori, d’une predisposition à payer (PAP). Les résultats n’ont pas fourni preuve qu’un programme multifactoriel de prévention des chutes a été rentable. L’adhésion des participants au recommandations allaient de faible (41,3%) à modéré (21,1%), à élevé (37,6%). Un défi futur sera de comprendre plus clairement la relation entre la personne âgée qui habite à une communauté avec les risques de chutes qui sont potentiellement modifiables, le respect des recommandations concernant les facteurs de risque multifactoriels, les coûts, et les effets qui en résultent de pratiques pour prévenir les chutes. Les futures évaluations économiques des interventions pour éviter les chutes restent nécessaires et devraient tenir compte du CRAN afin que les outils de régression puissent faciliter l’analyse coût-efficacité.

Keywords

vieillissementpersonnes âgéesprévention des chutesrapport coût-éfficacitérapport coût-éfficacité differentiel (RCED)cadre de regression de l’avantage netagingelderlyfalls preventioncost-effectivenessincremental cost-effectiveness ratio (ICER)net benefit regression framework (NBRF)
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 31 , Issue 2 , June 2012 , pp. 121 - 137
Copyright
Copyright © Canadian Association on Gerontology 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

This research was supported by funding received through a Transdisciplinary Understanding and Training on Research – Primary Health Care Program (TUTOR – PHC) training fellowship, and funding from the Ontario Neurotrauma Foundation in support of Injury Prevention, as well as funding received from Health Canada and Veterans Affairs Canada to complete the Project to Prevent Falls in Veterans Trial.

References

Alessi, C.A., Josephson, K.R., Harker, J.O., Pietruszka, F.M., Hoyl, M.T., & Rubenstein, L.Z. (2003). The yield, reliability, and validity of a postal survey for screening community-dwelling older people. Journal of the American Geriatrics Society, 51, 194–202.CrossRefGoogle ScholarPubMed
Aminzadeh, F. (2000). Adherence to recommendations of community-based comprehensive geriatric assessment programmes. Age and Ageing, 29(5), 401–407.CrossRefGoogle ScholarPubMed
Angus, D.E., Cloutier, E., Albert, T., Chenard, D., & Shariatmadar, A. (1998). The Economic Burden of Unintentional Injury in Canada. Toronto, Ontario, Canada: SmartRisk.Google Scholar
Barber, J.A., & Thompson, S.G. (1998). Analysis and interpretation of cost data in randomized controlled trials: Review of published studies. British Medical Journal, 317, 1195–1200.CrossRefGoogle ScholarPubMed
Becker, M.H. (1985). Patient adherence to prescribed therapies. Medical Care, 23(5), 539–555.CrossRefGoogle ScholarPubMed
Berg, K.O., Wood-Dauphine, S.L., Williams, J.I., & Gayton, D. (1989). Measuring balance in the elderly: Preliminary development of an instrument. Physiotherapy Canada, 41, 304–311.CrossRefGoogle Scholar
Briggs, A., & Gray, A. (2000). Using cost effectiveness information. British Medical Journal, 320, 246.CrossRefGoogle ScholarPubMed
Campbell, A.J., Robertson, M.C., La Grow, S.J., Kerse, N.M., Sanderson, G.F., Jacobs, R.J., et al. . (2005). Randomised controlled trial of prevention of falls in people aged > or =75 with severe visual impairment: the VIP trial. British Medical Journal, 331(7520), 817.CrossRefGoogle ScholarPubMed
Carroll, N.V., Stattum, P.W., & Cox, F.M. (2005). The cost of falls among community-dwelling elderly. Journal of Managed Care Pharmacy, 11, 307–316.CrossRefGoogle ScholarPubMed
Chang, J.T., Morton, S.C., Rubenstein, L.Z., Mojica, W.A., Maglione, M., Suttorp, M.J., et al. . (2004). Interventions for the prevention of falls in older adults: Systematic review and meta-analysis of randomised clinical trials. British Medical Journal, 328, 680.CrossRefGoogle ScholarPubMed
Craig, R., Dieppe, P., Macintyre, S., Michie, S., Nazereth, I., Petticrew, M., & Medical Research Council Guidance. (2008). Developing and evaluating complex interventions: The new Medical Research Council Guidance. British Medical Journal, 337, a1655.CrossRefGoogle ScholarPubMed
Davis, J.C., Robertson, M.C., Ashe, M.C., Liu-Ambrose, T., Khan, K.M., & Marra, C.A. (2010). Does a home-based strength and balance programme in people aged > or =80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions. British Journal of Sports Medicine, 44(2), 80–89.CrossRefGoogle ScholarPubMed
De Ridder, A., & De Graeve, D. (2009). Comparing the cost effectiveness of risperidone and olanzapine in the treatment of schizophrenia using the net-benefit regression approach. PharmacoEconomics, 27(1), 69–80.CrossRefGoogle ScholarPubMed
Drummond, M.F., Sculpher, M.J., Torrance, G.W., O’Brien, B.J., & Stoddart, G.L. (2005). Methods for the economic evaluation of health care programmes (3rd ed.). New York: Oxford University Press.CrossRefGoogle Scholar
Findorff, M.J., Wyman, J.F., Nyman, J.A., & Croghan, C.F. (2007). Measuring the direct health care costs of a fall injury event. Nursing Research, 56, 283–287.CrossRefGoogle ScholarPubMed
Fletcher, P.C., & Hirdes, J.P. (2002). Risk factors for falling among community-based seniors using home care services. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 57, M504–M510.CrossRefGoogle ScholarPubMed
Fuller, G.F. (2000). Falls in the elderly. American Family Physician, 61(7), 2159–2168, 2173–2174.Google ScholarPubMed
Gates, S., Fisher, J.D., Cooke, M.W., Carter, Y.H., & Lamb, S.E. (2008). Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: Systematic review and meta-analysis. British Medical Journal, 336(7636), 130–133. [Epub December 18, 2007].CrossRefGoogle ScholarPubMed
Gillespie, L.D., Gillespie, W.J., Robertson, M.C., Lamb, S.E., Cumming, R.G., & Rowe, B.H. (2003). Interventions for preventing falls in elderly people. Cochrane Database Systematic Reviews, CD000340.CrossRefGoogle ScholarPubMed
Graafmans, W.C., Ooms, M.E., Hofstee, H.M., Bezemer, P.D., Bouter, L.M., & Lips, P. (1996). Falls in the elderly: A prospective study of risk factors and risk profiles. American Journal of Epidemiology, 143, 1129–1136.CrossRefGoogle ScholarPubMed
Hendriks, M.R.C., Evers, S.M.A.A., Bleijlevens, M.H.C., van Haastregt, J.C.M., Crebolder, H.F.J.M., & van Eijk, J.T.M. (2008). Cost-effectiveness of a multidisciplinary fall prevention program in community-dwelling people: A randomized controlled trial (ISRCTN 64716113). International Journal of Technology Assessment in Health Care, 24(2), 193–202.CrossRefGoogle ScholarPubMed
Hoch, J.S., Briggs, A.H., & Willan, A.R. (2002). Something old, something new, something borrowed, something blue: A framework for the marriage of health econometrics and cost-effectiveness analysis. Health Economics, 11, 415–430.CrossRefGoogle Scholar
interRAI Community Health Assessment (CHA). Retrieved May 6, 2007, fromhttp://www.interrai.org.Google Scholar
Kleinbaum, D.G., Kupper, L.L., Muller, K.E., & Nizam, A. (1998). Applied regression analysis and other multivariable methods (3rd ed.). Pacific Grove, CA: Duxbury Press.Google Scholar
Koval, J.J., Pederson, L.L., Mills, C.A., McGrady, G.A., & Carvajal, S.C. (2000). Models of the relationship of stress, depression, and other psychosocial factors to smoking behavior: A comparison of a cohort of students in grades 6 and 8. Preventive Medicine, 30, 463–477.CrossRefGoogle ScholarPubMed
Laird, R.D., Studenski, S., Perera, S., & Wallace, D. (2001). Fall history is an independent predictor of adverse health outcomes and utilization in the elderly. American Journal of Managed Care, 7(12), 1133–1138.Google ScholarPubMed
Lamb, S.E., Fisher, J.D., Gates, S., Potter, R., Cooke, M.W., & Carter, Y.H. (2008). A national survey of services for the prevention and management of falls in the UK. BMC Health Services Research, 8, 233.CrossRefGoogle ScholarPubMed
Lamb, S.E., Jørstad-Stein, E.C., Hauer, K., & Becker, C. (2005). Development of a common outcome data set for fall injury prevention trials: The Prevention of Falls Network Europe consensus. Journal of the American Geriatrics Society, 53(9), 1618–1622.CrossRefGoogle ScholarPubMed
Last, J.M. (2001). A dictionary of epidemiology (4th ed.). International Epidemiology Association. New York: Oxford University Press.Google Scholar
Leduc, N., Tannenbaum, T.N., Bergman, H., Champagne, F., Clarfield, A.M., & Kogan, S. (1998). Compliance of frail elderly with health services prescribed at discharge from an acute-care geriatric ward. Medical Care, 36(6), 904–914.CrossRefGoogle ScholarPubMed
Morris, J.N., Bernabei, R., Ikegami, N., et al. . (2002). RAI-HOME CARE (RAI-HC) assessment Manual for Version 2.0: Primer on use of the Minimum Data Set for Home Care (MDS-HC) Version 2.0 and the Client Assessment Protocols (CAPS) for the use in Canada and the United States. Washington, DC: interRAI Corp.Google Scholar
O’Loughlin, J.L., Robitaille, Y., Boivin, J.F., & Suissa, S. (1993). Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. American Journal of Epidemiology, 137, 342–354.CrossRefGoogle ScholarPubMed
Ontario Case Costing Initiative (OCCI). (2004). Ontario Ministry of Health and Long-term Care, Ontario, Canada. 2004 Data. Retrieved November 10, 2007, fromhttp://www.occp.com/.Google Scholar
Rizzo, J.A., Baker, D.I., McAvay, G., & Tinetti, M.E. (1996). The cost-effectiveness of a multi-factorial targeted prevention program for falls among community elderly persons. Medical Care, 34, 954–969.CrossRefGoogle Scholar
Robertson, M.C., Devlin, N., Gardner, M.M., & Campbell, A.J. (2001a). Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial. British Medical Journal, 322, 697–701.CrossRefGoogle ScholarPubMed
Robertson, M.C., Devlin, N., Scuffham, P., Gardner, M.M., Buchner, D.M., & Campbell, A.J. (2001b). Economic evaluation of a community based exercise programme to prevent falls. Journal of Epidemiology and Community Health, 55, 600–606.CrossRefGoogle ScholarPubMed
Robertson, M.C., Gardner, M.M., Devlin, N., McGee, R., & Campbell, A.J. (2001c). Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 2: Controlled trial in multiple centres. British Medical Journal, 322, 701–704.CrossRefGoogle ScholarPubMed
Salkeld, G., Cumming, R.G., O’Neill, E., Thomas, M., Szonyi, G., & Westbury, C. (2000). The cost effectiveness of a home hazard reduction program to reduce falls among older persons. Australian and New Zealand Journal of Public Health, 24(3), 265–271.CrossRefGoogle ScholarPubMed
Shih, Y.T., Pan, I.-W., & Tsai, Y.-W. (2009). Information technology facilitates cost-effectiveness analysis in developing countries: An observational study of breast cancer chemotherapy in Taiwan. PharmacoEconomics, 27(11), 947–961.CrossRefGoogle ScholarPubMed
Smith, A.F., & Brown, G.C. (2000). Understanding cost effectiveness: A detailed review. British Journal of Ophthalmology, 84, 794–798.CrossRefGoogle ScholarPubMed
Smith, R.D., & Widiatmoko, D. (1998). The cost-effectiveness of home assessment and modification to reduce falls in the elderly. Australian and New Zealand Journal of Public Health, 22(4), 436–440.CrossRefGoogle ScholarPubMed
Speechley, M., Belfry, S., Borrie, M.J., Jenkyn, K.B., Crilly, R., Gill, D.P., et al. . (2005). Risk factors for falling among community-dwelling veterans and their caregivers. Canadian Journal on Aging, 24(3), 261–274.CrossRefGoogle ScholarPubMed
Stinnett, A.A., & Mullahy, J. (1998). Net health benefits: A new framework for the analysis of uncertainty in cost-effectiveness analysis. Medical Decision Making, 18, S68–S80.CrossRefGoogle ScholarPubMed
Stalenhoef, P.A., Diederiks, J.P., Knottnerus, J.A., Kester, A.D., & Crebolder, H.F. (2002). A risk model for the prediction of recurrent falls in community-dwelling elderly: A prospective cohort study. Journal of Clinical Epidemiology, 55, 1088–1094.CrossRefGoogle ScholarPubMed
Szklo, M., & Nieto, F.J. (Eds.). (2000). Epidemiology beyond the basics. Gaithersburg, MD: Aspen Publishers Inc.Google Scholar
Tambour, M., Zethraeus, N., & Johannesson, M. (1998). A note on confidence intervals in cost-effectiveness analysis. International Journal of Technology Assessment in Health Care, 14, 467–471.CrossRefGoogle ScholarPubMed
Tinetti, M.E., Speechley, M., & Ginter, S.F. (1988). Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 319, 1701–1707.CrossRefGoogle ScholarPubMed
Tinetti, M.E. (2008). Multifactorial fall-prevention strategies: Time to retreat or advance. Journal of the American Geriatrics Society, 56(8), 1563–1565.CrossRefGoogle ScholarPubMed
van Schoor, N.M., Smit, J.H., Pluijm, S.M., Jonker, C., & Lips, P. (2002). Different cognitive functions in relation to falls among older persons. Immediate memory as an independent risk factor for falls. Journal of Clinical Epidemiology, 55, 855–862.CrossRefGoogle ScholarPubMed
Wiktorowicz, M.E., Goreree, R., Papaioannaou, A., Adachi, D., & Papadimitropoulos, E. (2001). Economic implications of Hip Fracture: Health Service Use, Institutional Care and Cost in Canada. Osteoporosis International, 12, 271–278.CrossRefGoogle ScholarPubMed