School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
Age Ageing. 2010 Nov;39(6):710-6. doi: 10.1093/ageing/afq108. Epub 2010 Sep 10.
multifactorial falls prevention programmes for older people have been proved to reduce falls. However, evidence of their cost-effectiveness is mixed.
economic evaluation alongside pragmatic randomised controlled trial.
randomised trial of 364 people aged ≥70, living in the community, recruited via GP and identified as high risk of falling. Both arms received a falls prevention information leaflet. The intervention arm were also offered a (day hospital) multidisciplinary falls prevention programme, including physiotherapy, occupational therapy, nurse, medical review and referral to other specialists.
self-reported falls, as collected in 12 monthly diaries. Levels of health resource use associated with the falls prevention programme, screening (both attributed to intervention arm only) and other health-care contacts were monitored. Mean NHS costs and falls per person per year were estimated for both arms, along with the incremental cost-effectiveness ratio (ICER) and cost effectiveness acceptability curve.
in the base-case analysis, the mean falls programme cost was £349 per person. This, coupled with higher screening and other health-care costs, resulted in a mean incremental cost of £578 for the intervention arm. The mean falls rate was lower in the intervention arm (2.07 per person/year), compared with the control arm (2.24). The estimated ICER was £3,320 per fall averted.
the estimated ICER was £3,320 per fall averted. Future research should focus on adherence to the intervention and an assessment of impact on quality of life.
多项针对老年人的多因素防跌倒计划已被证明可降低跌倒风险。然而，关于其成本效益的证据却存在差异。
在一项实用随机对照试验中进行经济评估。
一项针对 364 名年龄≥70 岁、居住在社区、通过全科医生招募并被确定为高跌倒风险的人的随机试验。两组均收到一份防跌倒信息传单。干预组还提供了（日间医院）多学科防跌倒计划，包括物理治疗、职业治疗、护士、医疗审查和转介给其他专家。
通过 12 个月的日记收集自我报告的跌倒情况。监测与防跌倒计划、筛查（均仅归因于干预组）和其他医疗保健接触相关的健康资源使用水平。估计两组的 NHS 平均成本和每人每年的跌倒次数，以及增量成本效益比（ICER）和成本效益可接受性曲线。
在基本案例分析中，防跌倒计划的平均每人费用为 349 英镑。这加上更高的筛查和其他医疗保健成本，导致干预组的平均增量成本为 578 英镑。干预组的平均跌倒率（2.07 人/年）低于对照组（2.24 人/年）。估计的 ICER 为每避免一次跌倒 3320 英镑。
估计的 ICER 为每避免一次跌倒 3320 英镑。未来的研究应侧重于干预措施的依从性和对生活质量的影响评估。
