Effectiveness and cost-effectiveness of a single home-based fall prevention program: a prospective observational study based on questionnaires and claims data

Abstract

Background: Fall prevention programmes are essential interventions in societies with aging populations. This study assessed the fall rate and other health outcomes, as well as the cost-effectiveness of a home-based fall prevention programme for community-dwelling older people. In a single home visit, trained physical or occupational therapists performed fall risk assessments, eliminated environmental risk factors, and provided tailored exercises.

Methods: A prospective, longitudinal observational study was performed with participants of a fall prevention programme who agreed to be followed-up over one year. Baseline data included self-reported falls one month and one year before the intervention. Participants were monitored through bi-monthly telephone calls, assessing their number of falls, fear of falling (using the Falls Efficacy Scale-International (FES-I), quality of life (using the EuroQuol-5 Dimensions-5 Levels, EQ-5D-5L), and physical activity (in minutes per week). Statistical analysis of the data used a Generalized Estimating Equations (GEE) Poisson-Modell for number of falls and a Linear Mixed Model (LMM) for fear of falling, quality of life and physical activity. In addition, health insurance claims data were used to compare the number of medically treated falls in the year before and after the intervention, as well as the related healthcare spending. Cost-effectiveness of the programme versus usual care was estimated as cost per prevented medically treated fall.

Results: Overall, 639 person-years of observation time were analyzed. Participants had a mean age of 81.8 years (+/- 5.2) and 59% were female. On average, the fall rate decreased from 1.35 to 1.02 per person-year, or -23.9% (95%CI from -35.92 to -9.67), fear of falling decreased by -1.27 points (95%CI from -1.50 to -1.05), quality of life improved by -0.88 points (95%CI from -1.09 to -0.68), and physical activity increased by 9.87 min per day (95%CI from 5.65 to 14.09). Analysis of claims data showed a 48.0% reduction (95%CI from 30.5% to 61.0%) in medically treated falls. The average cost per prevented medically treated fall was estimated at approximately 1,353 USD, with a 50% probability of the intervention being cost saving.

Conclusions: This fall prevention programme with a single home visit was found to be effective and cost effective. Health policies should establish such a model as a reimbursed standard care to assist in combatting the increasing burden of falls on individuals and societies.

Keywords: Cost; Cost-effectiveness; Effectiveness; Falls; Prevention.

Fig. 1

Overview of study procedures and assessments SLAR: Swiss League Against Rheumatism; PT: physiotherapist, OT: occupational therapist, FES-I = Falls Efficacy Scale-International; EQ-5D- 5 L = EuroQuol-5 Dimensions-5 Levels; PA = Physical activity, minutes/week spent ‘walking’; SE = Self-efficacy, related to the given recommendations and the instructed exercises; PGICS = Patient Global Impression of Change Scale *health problems = need of visual aid, balance problems, pain while walking, problems getting up from chair, dizziness, use of walking aid **fall risk assessment: (a) checklist on health behaviors and intrinsic risk factors for falls; (b) three functional tests: 1) FCST = (Five) Chair Stand Test; TUG = Timed Up and Go (including TUGmot = TUG with additional motor task; and TUGcog = TUG with additional cognitive task); 3) Getting-up-from-floor

Fig. 2

Study flow SLAR = Swiss League Against Rheumatism

Fig. 3

Cost-effectiveness plane and ICER ICER = incremental cost effectiveness ratio; CE = confidence ellipses Notes: This figure shows the cost-effectiveness plane with the net costs on the y-axis and the number of prevented falls on the x-axis. The ICER amounts to USD 1’296 (= 81’645 / 63). The confidence ellipses are drawn at the 50%, 75% and 95%-Level