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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])
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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

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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.

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