Developing a fall prevention intervention economic model

Abstract

Purpose: Model-based economic evaluations require conceptualization of the model structure. Our objectives were to identify important health states, events, and patient attributes to be included in a model-based cost-effectiveness analysis of fall prevention interventions, to develop a model structure to examine cost-effectiveness of fall prevention interventions, and to assess the face validity of the model structure.

Methods: An expert panel comprising clinicians, health service researchers, health economists, a patient partner, and policy makers completed two rounds of online surveys to gain consensus on health states, events, and patient attributes important for fall prevention interventions. The surveys were informed by a literature search on fall prevention interventions for older adults (≥65 years) including economic evaluations and clinical practice guidelines. The results of the Delphi surveys and subsequent discussions can support the face validity of a state-transition model for an economic evaluation of fall prevention interventions.

Results: In total, 11 experts rated 24 health states/events and 41 patient attributes. Consensus was achieved on 14 health states/events and 26 patient characteristics. The proposed model structure incorporated 12 of the 14 selected health states/events. Panelists confirmed the face validity of the model structure during teleconferences.

Conclusions: There is a dearth of studies presenting the model conceptualization process; consequently, this study involving multiple end user partners with opportunities for input at several stages adds to the literature as another case study. This process is an example of how a fall prevention economic model was developed using a modified Delphi process and assessed for face validity.

Fig 1. Model structure.

Community setting: includes people who are living in settings such as their own home, retirement home, supportive housing or assisted living; Residential aged care setting: includes people living in settings such as long-term care facilities, nursing homes or residential care; Hospital: includes hospital inpatient Rehabilitation hospital: includes rehabilitation hospital inpatients; Death due to a fall: represents those who died as a result of a fall; Death: represents those who died by any cause other than a fall; ED: emergency department visit; Injury: includes hip fracture, vertebral fracture, wrist fracture, and head injury; Surgery: hip fracture surgery.