Model-based economic evaluation of ice cleat distribution programmes for the prevention of outdoor falls among adults from a Swedish societal perspective

Abstract

Background: Slipping on snow or ice poses a significant health risk among older adults in Sweden. To combat this problem, about 80 Swedish municipalities have distributed ice cleats to older citizens (65+ years old) over the last decade. This paper details a cost-benefit analysis of such programmes.

Materials and methods: We developed a decision-analytical model to estimate the costs and benefits of ice cleat programmes in Swedish municipalities compared with a business-as-usual scenario. The modelled benefits of the programme were based on effect estimates from previous research, data from population and healthcare registers and a survey of attitudes to and actual ice cleat use. The modelled costs of the programme were based on resource use data collected from 34 municipalities with existing ice cleat programmes. We assessed heterogeneity in the potential impact and benefit-to-cost ratios across all Swedish municipalities as a function of the average number of days with snow cover per year. Uncertainty in the cost-benefit results was assessed using deterministic and probabilistic sensitivity analyses.

Results: The average benefit-to-cost ratio was 87, ranging from about 40 in low-risk municipalities to 140 in high-risk municipalities, implying that the potential benefits of ice cleat programmes greatly outweigh their costs. Probabilistic and deterministic sensitivity analyses support the robustness of this conclusion to parameter uncertainty and large changes in assumptions about the magnitude of the impact on ice cleat use and injuries.

Conclusion: The benefits of distributing ice cleats to older adults appear to outweigh the costs from a Swedish societal perspective.

Keywords: economic analysis; fall; older people; uptake/adherence.

Figure 1

Maps of Sweden’s 290 municipalities that illustrate the geographical variation in (A) estimated benefit-to-cost ratios from our economic simulations (base-case scenario), (B) baseline snow-related or ice-related fall injury rates per 100 000 person-years, (C) the estimated proportion of ice cleat users per municipality without ice cleat distribution programmes and (D) the estimated proportion of the population susceptible to change as a consequence of an ice cleat distribution programme (non-users with a positive attitude towards the efficacy of ice cleats).