Cost-effectiveness of a statewide falls prevention program in Pennsylvania: Healthy Steps for Older Adults

Abstract

Objectives: Pennsylvania's Department of Aging has offered a falls prevention program, "Healthy Steps for Older Adults" (HSOA), since 2005, with about 40,000 older adults screened for falls risk. In 2010 to 2011, older adults 50 years or older who completed HSOA (n = 814) had an 18% reduction in falls incidence compared with a comparison group that attended the same senior centers (n = 1019). We examined the effect of HSOA on hospitalization and emergency department (ED) treatment, and estimated the potential cost savings.

Study design: Decision-tree analysis.

Methods: The following were included in a decision-tree model based on a prior longitudinal cohort study: costs of the intervention, number of falls, frequency and costs of ED visits and hospitalizations, and self-reported quality of life of individuals in each outcome condition. A Monte Carlo probabilistic sensitivity analysis assigned appropriate distributions to all input parameters and evaluated model results over 500 iterations. The model included all ED and hospitalization episodes rather than just episodes linked to falls.

Results: Over 12 months of follow-up, 11.3% of the HSOA arm and 14.8% of the comparison group experienced 1 or more hospitalizations (P = .04). HSOA participants had less hospital care when matched for falls status. Observed values suggest expected costs per participant of $3013 in the HSOA arm and $3853 in the comparison condition, an average savings of $840 per person. Results were confirmed in Monte Carlo simulations ($3164 vs $3882, savings of $718).

Conclusions: The savings of $718 to $840 per person is comparable to reports from other falls prevention economic evaluations. The advantages of HSOA include its statewide reach and integration with county aging services.