Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-26T05:24:17.777Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-effectiveness of fall prevention programs based on home visits for seniors aged over 65 years: a systematic review

Published online by Cambridge University Press:  12 January 2011

Sandro Corrieri ,
Dirk Heider ,
Steffi G. Riedel-Heller ,
Herbert Matschinger  and
Hans-Helmut König
Sandro Corrieri*
Affiliation:
Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
Dirk Heider
Affiliation:
Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
Steffi G. Riedel-Heller
Affiliation:
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
Herbert Matschinger
Affiliation:
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
Hans-Helmut König
Affiliation:
Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
*
Correspondence should be addressed to: Sandro Corrieri, Selbständige Abteilung für Sozialmedizin, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany. Phone: +49 341 97 15420; Fax: +49 341 97 15409. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Preventive home visits (PHVs) are considered a promising intervention to improve health and independent functioning of the elderly whilst reducing health care costs. This systematic review focuses on cost-effectiveness of PHVs, analyzing randomized controlled trials evaluating incremental cost-effectiveness ratios in fall prevention interventions.

Methods: Based on an online search (PubMed) and bibliographic findings in the eligible articles, five studies providing relevant information were reviewed.

Results: While three studies indicate cost-effectiveness, one delivered no statistically significant results, and one proved cost-effectiveness only for a subgroup of the study sample.

Conclusions: Cost-effectiveness of PHVs appears to depend on careful adaptation of particular measures, for certain settings in special environments for designated patients and disease patterns, on a case-by-case basis. Starting points for further research are the components of the economic evaluation, the setting, personnel and measures of the intervention, as well as the careful selection and analysis of the study sample and its subgroups. A uniform follow-up time, standardized cost measurement as well as the use of standardized denominators like quality adjusted life years (based on the EQ-5D questionnaire) could build a foundation for comparable results.

Keywords

quality of lifefallshealth economics
Type
Review Article
Information
International Psychogeriatrics , Volume 23 , Issue 5 , June 2011 , pp. 711 - 723
Copyright
Copyright © International Psychogeriatric Association 2011

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.)

References

Antonovsky, A. (1979). Health, Stress and Coping. San Francisco, CA: Jossey-Bass.Google Scholar
Bergner, M., Hudson, L. D., Conrad, D. A., Patmont, C. M., McDonald, G. J., Perrin, E. B. and Gilson, B. S. (1988). The cost and efficacy of home care for patients with chronic lung disease. Medical Care, 26, 566–579.CrossRefGoogle ScholarPubMed
Bernabei, R. et al. (1998). Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ, 316, 1348–1351.CrossRefGoogle ScholarPubMed
Bouman, A., van Rossum, E., Evers, S., Ambergen, T., Kempen, G. and Knipschild, P. (2008). Effects on health care use and associated cost of a home visiting program for older people with poor health status: a randomized clinical trial in the Netherlands. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 63, 291–297.CrossRefGoogle ScholarPubMed
Braithwaite, R. S., Meltzer, D. O., KingJ. T., Jr. J. T., Jr., Leslie, D. and Roberts, M. S. (2008). What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule? Medical Care, 46, 349–356.CrossRefGoogle Scholar
Campbell, A. J., Borrie, M. J. and Spears, G. F. (1989). Risk factors for falls in a community-based prospective study of people 70 years and older. Journal of Gerontology, 44, M112–M117.CrossRefGoogle Scholar
Campbell, A. J. et al. (2005). Randomised controlled trial of prevention of falls in people aged ≥75 with severe visual impairment: the VIP trial. BMJ, 331, 817.CrossRefGoogle ScholarPubMed
Carpenter, G. I. and Demopoulos, G. R. (1990). Screening the elderly in the community: controlled trial of dependency surveillance using a questionnaire administered by volunteers. BMJ, 300, 1253–1256.CrossRefGoogle ScholarPubMed
Clark, J. (2001). Preventive home visits to elderly people. British Medical Journal, 323, 708.CrossRefGoogle ScholarPubMed
Cumming, R. G. et al. (1999). Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. Journal of the American Geriatrics Society, 47, 1397–1402.CrossRefGoogle ScholarPubMed
Drummond, M., Sculpher, M. J., Torrance, G. W., O'Brien, B. and Stoddart, G. L. (2005). Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press.CrossRefGoogle Scholar
Egger, M. (2001). Commentary: when, where, an why do preventive home visits work? BMJ, 323, 724–725.Google Scholar
Elkan, R. et al. (2000). The effectiveness of domiciliary health visiting: a systematic review of international studies and a selective review of the British literature. Health Technology Assessment, 4, 1–339.CrossRefGoogle Scholar
Elkan, R. et al. (2001). Effectiveness of home based support for older people: systematic review and meta-analysis. BMJ, 323, 719–725.CrossRefGoogle ScholarPubMed
Fitzmaurice, G., Davidian, M., Verbeke, G. and Molenberghs, G. (2009). Longitudinal Data Analysis. Handbook of Modern Statistical Methods. Boca Raton: Taylor & Francis.Google Scholar
Hébert, R. and Dion, M. H. (2001). Efficacy of in-home screening for risk of functional decline. Age and Ageing, 30, 265–266.CrossRefGoogle ScholarPubMed
Heinrich, S., Rapp, K., Rissmann, U., Becker, C. and Konig, H. H. (2010). Cost of falls in old age: a systematic review. Osteoporosis International, 21, 891–902.CrossRefGoogle ScholarPubMed
Hendriks, M. R., Evers, S. M., Bleijlevens, M. H., van Haastregt, J. C., Crebolder, H. F. and van Eijk, J. T. (2008). Cost-effectiveness of a multidisciplinary fall prevention program in community-dwelling elderly people: a randomized controlled trial (ISRCTN 64716113). International Journal of Technology Assessment in Health Care, 24, 193–202.CrossRefGoogle ScholarPubMed
Hendriksen, C., Lund, E. and Stromgard, E. (1984). Consequences of assessment and intervention among elderly people: a three year randomised controlled trial. BMJ, 289, 1522–1524.CrossRefGoogle ScholarPubMed
Kronborg, C., Vass, M., Lauridsen, J. and Avlund, K. (2006). Cost effectiveness of preventive home visits to the elderly: economic evaluation alongside randomized controlled study. European Journal of Health Economics, 7, 238–246.CrossRefGoogle Scholar
Landi, F. et al. (2001). Impact of a new assessment system, the MDS-HC, on function and hospitalization of homebound older people: a controlled clinical trial. Journal of the American Geriatrics Society, 49, 1288–1293.CrossRefGoogle ScholarPubMed
Mann, W. C., Ottenbacher, K. J., Fraas, L., Tomita, M. and Granger, C. V. (1999). Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly: a randomized controlled trial. Archives of Family Medicine, 8, 210–217.CrossRefGoogle ScholarPubMed
Markle-Reid, M., Browne, G., Weir, R., Gafni, A., Roberts, J. and Henderson, S. R. (2006a). The effectiveness and efficiency of home-based nursing health promotion for older people: a review of the literature. Medical Care Research and Review, 63, 531–569.CrossRefGoogle ScholarPubMed
Markle-Reid, M., Weir, R., Browne, G., Roberts, J., Gafni, A. and Henderson, S. (2006b). Health promotion for frail older home care clients. Journal of Advanced Nursing, 54, 381–395.CrossRefGoogle ScholarPubMed
Markle-Reid, M., Browne, G., Weir, R., Gafni, A., Roberts, J. and Henderson, S. (2008). Seniors at risk: the association between the six-month use of publicly funded home support services and quality of life and use of health services for older people. Canadian Journal of Aging, 27, 207–224.CrossRefGoogle ScholarPubMed
Melis, R. J. et al. (2008). Cost-effectiveness of a multidisciplinary intervention model for community-dwelling frail older people. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 63, 275–282.CrossRefGoogle ScholarPubMed
Mitchell, C., Walker, J., Walters, S., Morgan, A. B., Binns, T. and Mathers, N. (2005). Costs and effectiveness of pre- and post-operative home physiotherapy for total knee replacement: randomized controlled trial. Journal of Evaluation in Clinical Practice, 11, 283–292.CrossRefGoogle ScholarPubMed
Muthén, B. (2004). Latent variable analysis: growth mixture modeling and related techniques for longitudinal data. In Muthén, B. (ed.), Handbook of Quantitative Methodology for the Social Sciences (pp. 345–368). Newbury Park: Sage Publications.Google Scholar
National Institute for Health and Clinical Excellence (2010). Assessing cost effectiveness. In The Guidelines Manual 2009, London: NICE. Available at: http://www.nice.org.uk/media/68D/29/The_guidelines_manual_2009_-_Chapter_7_Assessing_cost_effectiveness.pdf.Google Scholar
OECD (2010). OECD Stat Extracts. Paris: Organisation for Economic Co-operation and Development. Available at: http://stats.oecd.org.Google Scholar
Oktay, J. S. and Volland, P. J. (1987). Foster home care for the frail elderly as an alternative to nursing home care: an experimental evaluation. American Journal of Public Health, 77, 1505–1510.CrossRefGoogle ScholarPubMed
Raftery, J. P. et al. (1996). A randomized controlled trial of the cost-effectiveness of a district co-ordinating service for terminally ill cancer patients. Palliative Medicine, 10, 151–161.CrossRefGoogle ScholarPubMed
Rasanen, P., Roine, E., Sintonen, H., Semberg-Konttinen, V., Ryynanen, O. P. and Roine, R. (2006). Use of quality-adjusted life years for the estimation of effectiveness of health care: a systematic literature review. International Journal of Technology Assessment in Health Care, 22, 235–241.CrossRefGoogle ScholarPubMed
Rizzo, J. A., Baker, D. I., McAvay, G. and Tinetti, M. E. (1996). The cost-effectiveness of a multifactorial targeted prevention program for falls among community elderly persons. Medical Care, 34, 954–969.CrossRefGoogle ScholarPubMed
Robertson, M. C., Devlin, N., Gardner, M. M. and 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., Gardner, M. M., Devlin, N., McGee, R. and Campbell, A. J. (2001b). 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
Sahlen, K. G., Lofgren, C., Mari, H. B. and Lindholm, L. (2008). Preventive home visits to older people are cost-effective. Scandinavian Journal of Public Health, 36, 265–271.CrossRefGoogle ScholarPubMed
Salkeld, G., Cumming, R. G., O'Neill, E., Thomas, M., Szonyi, G. and 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, 265–271.CrossRefGoogle ScholarPubMed
Sattin, R. W. (1992). Falls among older persons: a public health perspective. Annual Review of Public Health, 13, 489–508.CrossRefGoogle Scholar
Stuck, A. E. et al. (1995). A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. New England Journal of Medicine, 333, 1184–1189.CrossRefGoogle ScholarPubMed
Stuck, A. E. et al. (2000). A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission. Archives of Internal Medicine, 160, 977–986.CrossRefGoogle ScholarPubMed
Taylor, P. D. (2002). Evaluation is essential for all types of intervention. BMJ, 324, 300.CrossRefGoogle ScholarPubMed
Tinetti, M. E., Speechley, M. and 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., Liu, W. L. and Claus, E. B. (1993). Predictors and prognosis of inability to get up after falls among elderly persons. JAMA, 269, 65–70.CrossRefGoogle ScholarPubMed
Tinetti, M. E. et al. (1994). A multifactorial intervention to reduce the risk of falling among elderly people living in the community. New England Journal of Medicine, 331, 821–827.CrossRefGoogle ScholarPubMed
van Haastregt, J. C., Diederiks, J. P., van Rossum, E., de Witte, L. P., Voorhoeve, P. M. and Crebolder, H. F. (2000). Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial. BMJ, 321, 994–998.CrossRefGoogle ScholarPubMed
van Rossum, E., Frederiks, C. M., Philipsen, H., Portengen, K., Wiskerke, J. and Knipschild, P. (1993). Effects of preventive home visits to elderly people. BMJ, 307, 27–32.CrossRefGoogle ScholarPubMed
Wancata, J. and Meise, U. (2009). Research instruments in social psychiatry research. Psychiatric Praxis, 36, 368–372.CrossRefGoogle ScholarPubMed