ECONOMIC EVALUATIONS OF FALL PREVENTION EXERCISE PROGRAMS: A SYSTEMATIC REVIEW

C. Sherrington^1,2, M. Pinheiro^1,2, K. Howard¹, P. Caldwell^1,2, A. Tiedemann^1,2, B. Wang^1,2, J. Oliveira^1,2, A. Santos³, F. Bull³, J. Willumsen³, Z. Michaleff^1,2, S. Ferguson^1,2, E. Mayo^1,2, N. Fairhall^1,2, A. Bauman¹, S. Norris¹

¹University of Sydney, School of Public Health, Sydney, Australia, ²Sydney Local Health District, Institute for Musculoskeletal Health, Sydney, Australia, ³World Health Organization, Physical Activity Unit, Geneva, Switzerland

Background: Exercise reduces the risk of falls in older adults living in the community, and multicomponent programs that target both strength and balance and programs that include balance/function training appear to be particularly effective. In aged care facilities, the role of exercise for fall prevention is less clear but promising. No reviews to date have summarised and critically appraised the evidence on the cost-effectiveness and costs of fall prevention exercise programs as a single intervention for older adults living in the community and aged care facilities.

Purpose: To investigate cost-effectiveness and costs of fall prevention exercise programs for older adults.

Methods: We conducted a systematic review. We searched Medline, Embase, Web of Science, Scopus,NHS EED, HTA database, Tufts CEA Registry, RePEc and EconLit (inception to May 2022). We included economic evaluations (trial- or model-based) and costing studies investigating fall prevention exercise programs 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. Two reviewers selected studies and assessed quality using the Extended Consensus on Health Economic Criteria list (CHEC-list) for economic evaluations and a modified version of the CHEC-list for costing studies. GRADE style ratings assessed the overall certainty of each economic evaluation. Results were summarised via narrative synthesis.

Results: 31 studies were included. For community-dwelling older adults (21 economic evaluations, six costing studies), results ranged from more effective and less costly (dominant) interventions up to an ICER of $279,802/QALY gained and $11,986/fall prevented (US 2020). Assuming an arbitrary willingness to pay threshold ($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 (2 economic evaluations, 2 costing studies), ICERs ranged from dominant (low certainty) to $35/fall prevented (moderate certainty). Overall, intervention costs varied and were poorly reported.

Conclusions: Most economic evaluations investigated fall prevention exercise programs for older adults living in the community. There is moderate certainty evidence that fall prevention exercise programs are likely to be cost-effective. The evidence for older adults living in care facilities is more limited but promising.

Implications: Supervised fall prevention exercise programs, delivered to older adults living in the community are likely to offer good value for money, particularly when delivered to “older” old people (e.g. aged 80+) and people with high fall risk. The evidence for programs delivered to older adults living in care facilities is more limited, but promising, highlighting the need for more studies in this setting. The intervention costs summarised in this review should be interpreted with consideration of the type of exercise, duration, level of supervision and number of participants and can be used for planning the implementation of future programs or future models investigating the value for money of such programs.

Funding acknowledgements: This work was prepared for and funded by the Physical Activity Unit, Department of Health Promotion, World Health Organization (WHO).

Keywords:
falls
cost-effectiveness
exercise

Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Older people
Service delivery/emerging roles

Did this work require ethics approval? No

Reason: This is a systematic review