Economic evaluations of fall prevention exercise programs: a systematic review

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.

Keywords: Accidental Falls; Aged; Economics; Exercise; Review.

Figure 1

Incremental cost-effectiveness ratios (ICERs) expressed as additional cost per quality-adjusted life year (QALY) gained from economic evaluations of fall prevention exercise programmes for older adults living in the community. Results are presented separately for model-based and trial-based analyses. Costs are expressed as 2020 US$. Dominant interventions (ie, more effective and less costly) are shown on the zero line. Same colours and numbers indicate same study. Closed circles indicate moderate level of certainty and open circles indicate low level of certainty. Uncertainty intervals are not displayed as most studies did not report it.

Figure 2

Incremental cost-effectiveness ratios (ICERs) expressed as additional cost per fall prevented from economic evaluations of fall prevention exercise programmes. *Costs are expressed as 2020 US$. Results are presented separately for model-based and trial-based analyses. Dominant interventions (ie, more effective and less costly) are shown on the zero line. Same colours and numbers indicate same study. Closed circles indicate moderate level of certainty and open circles indicate low level of certainty. Uncertainty intervals are not displayed as most studies did not report it.

Figure 3

Incremental cost-effectiveness ratios (ICERs) expressed as additional cost per QALY gained from economic evaluations of fall prevention exercise programmes according to exercise type. Multi, multicomponent; NS, exercise type not specified. Results are presented separately for model- and trial-based analyses Costs are expressed as 2020 US$. Dominant interventions (ie, more effective and less costly) are shown on the zero line. Same colours and numbers indicate same study. Closed circles indicate moderate level of certainty and open circles indicate low level of certainty. Uncertainty intervals are not displayed as most studies did not report it.

Figure 4

Incremental cost-effectiveness ratios (ICERs) expressed as additional cost per fall prevented from economic evaluations of fall prevention exercise programmes according to exercise type. Multi, multicomponent; NS, exercise type not specified. Results are presented separately for model-based and trial-based analyses *Costs are expressed as 2020 US$. Dominant interventions (ie, more effective and less costly) are shown on the zero line. Same colours and numbers indicate same study. Closed circles indicate moderate level of certainty and open circles indicate low level of certainty. Uncertainty intervals are not displayed as most studies did not report it.

Figure 5

Incremental cost-effectiveness ratios (ICERs) expressed as additional cost per QALY gained from economic evaluations of fall prevention exercise programmes according to level of supervision. Results are presented separately for model-based and trial-based analyses Costs are expressed as 2020 US$. Dominant interventions (ie, more effective and less costly) are shown on the zero line. Same colours and numbers indicate same study. Closed circles indicate moderate level of certainty and open circles indicate low level of certainty. Uncertainty intervals are not displayed as most studies did not report it.

Figure 6

Incremental cost-effectiveness ratios (ICERs) expressed as additional cost per fall prevented from economic evaluations of fall prevention exercise programmes according to level of supervision. Results are presented separately for model-based and trial-based analyses. *Costs are expressed as 2020 US$. Dominant interventions (ie, more effective and less costly) are shown on the zero line. Same colours and numbers indicate same study. Closed circles indicate moderate level of certainty and open circles indicate low level of certainty. Uncertainty intervals are not displayed as most studies did not report it.

Figure 7

Incremental cost-effectiveness ratios (ICERs) expressed as additional cost per quality-adjusted life year (QALY) gained from economic evaluations of fall prevention exercise programmes according to baseline characteristics explored within the study. Costs are expressed as 2020 US$. Dominant interventions (ie, more effective and less costly) are shown on the zero line. Same colours and numbers indicate same study. Closed circles indicate moderate level of certainty and open circles indicate low level of certainty. Uncertainty intervals are not displayed as most studies did not report it.

Figure 8

Incremental cost-effectiveness ratios (ICERs) expressed as additional cost per fall prevented from economic evaluations of fall prevention exercise programmes according to baseline characteristics explored within the study. *Costs are expressed as 2020 US$. Dominant interventions (ie, more effective and less costly) are shown on the zero line. Same colours and numbers indicate same study. Closed circles indicate moderate level of certainty and open circles indicate low level of certainty. Uncertainty intervals are not displayed as most studies did not report it.