Economic evaluations of fall prevention exercise programs: a systematic review. Issue 23 (27th October 2022)

• Record Type: Journal Article
• Authors: Pinheiro, Marina B; Sherrington, Catherine; Howard, Kirsten; Caldwell, Patrick; Tiedemann, Anne; Wang, Belinda; S Oliveira, Juliana; Santos, Andreia; Bull, Fiona C; Willumsen, Juana F; Michaleff, Zoe A; Ferguson, Sarah; Mayo, Eleesheva; Fairhall, Nicola J; Bauman, Adrian E; Norris, Sarah
• Is Part Of: British journal of sports medicine. Volume 56:Issue 23(2022)
• Page Start: 1353
• Page End: 1365
• Publication Date: 2022-10-27
• Subjects: Economics -- Accidental Falls -- Exercise -- Review -- Aged; Sports medicine -- Periodicals; 617.1027
• DOI: 10.1136/bjsports-2022-105747
• Languages: English
• ISSNs: 0306-3674

Abstract

Abstract : Objective: To investigate cost-effectiveness and costs of fall prevention exercise programmes for older adults. Design: Systematic review. Data sources: Medline, Embase, Web of Science, Scopus, National Institute for Health Research Economic Evaluation Database, Health Technology Assessment database, Tufts Cost-Effectiveness Analysis Registry, Research Papers in Economics and EconLit (inception to May 2022). Eligibility criteria for study selection: Economic evaluations (trial-based or model-based) and costing studies investigating fall prevention exercise programmes versus no intervention or usual care for older adults living in the community or care facilities, and reporting incremental cost-effectiveness ratio (ICER) for fall-related outcomes or quality-adjusted life years (QALY, expressed as cost/QALY) and/or intervention costs. Results: 31 studies were included. For community-dwelling older adults (21 economic evaluations, 6 costing studies), results ranged from more effective and less costly (dominant) interventions up to an ICER of US$279 802/QALY gained and US$11 986/fall prevented (US$ in 2020). Assuming an arbitrary willingness-to-pay threshold (US$100 000/QALY), most results (17/24) were considered cost-effective (moderate certainty). The greatest value for money (lower ICER/QALY gained and fall prevented) appeared to accrue for older adults and those with high fall risk, but unsupervised exercise appeared to offer poor value for money (higher ICER/QALY). For care facilities (two economic evaluations, two costing studies), ICERs ranged from dominant (low certainty) to US$35/fall prevented (moderate certainty). Overall, intervention costs varied and were poorly reported. Conclusions: Most economic evaluations investigated fall prevention exercise programmes for older adults living in the community. There is moderate certainty evidence that fall prevention exercise programmes are likely to be cost-effective. The evidence for older adults living in care facilities is more limited but promising. PROSPERO registration number: PROSPERO 2020 CRD42020178023.