Cost-effectiveness analysis of the digital fall preventive intervention Safe Step among community-dwelling older people aged 70 and older

Abstract

Falls are the most common cause of injury in older people, with consequences for the individual and society. With an increasing population of older people, falls and related costs are expected to increase. It is crucial to identify scalable and cost-effective interventions and subsequently reduce fall-related costs. The aim was to evaluate the cost-effectiveness of the Safe Step digital fall preventive exercise intervention over a period of 12 years and, in addition, to evaluate the impact of increased recruitment cost and decreased intervention effect. The intervention was evaluated in an observational study in a municipality context targeting community-dwelling older people of age 70 + . A Markov model with five states was used to model the cost-effectiveness of the Safe Step intervention and evaluate quality-adjusted life years (QALYs) and fall-related costs from a societal perspective. By using data from a meta-analysis as basis for the estimated intervention effect, the Safe Step intervention was compared with a no-intervention alternative. The results showed that the Safe Step intervention dominated no intervention. In the sensitivity analysis with the most conservative estimate of intervention effect, the ICER was €7 616 per QALY gained. Hence, Safe Step showed to be a cost-saving fall preventive intervention in older people at risk of falling and potentially cost-effective even with a low estimated intervention effect. Future studies on efficacy of fall preventive digital interventions will contribute in precising effect estimates and enhance the validity of these cost-effectiveness results.

Keywords: Accidental falls; Balance and strength exercise; Cost-effectiveness; Digital health; Reach; mHealth.

Fig. 1

Markov model (states are shown in rectangles, straight arrows represent transition probabilities from one state to the other, curved arrows represent probabilities to remain in the same state). State A (At risk for fall) refers to a state where a person either has fallen previously or perceives a decline in balance. A fall in state A does not require any medical attention nor impact daily functioning (such as increased need for informal care or home help). State B (Minor consequences after a fall) refers to a state in which a person has experienced a fall that has led to a visit to the emergency care department without being admitted to hospital. A fall in state B is assumed to have no impact on daily functioning (such as increased need for informal care or home help) but might require follow-up visits for rehabilitation. State C (Major consequences after a fall) refers to a state where a person has experienced a fall which has led to an emergency visit and hospital admission. On discharge from the hospital, the person will require rehabilitation; this fall will impact daily functioning (such as increased need for informal care or home help). State D (Special housing after a fall) refers to a state where a person has experienced a fall that has led to need for long-term care in special housing. Persons in state D are assumed to remain in this state over time or transition to state E (Death)