Economic evaluations of fall prevention exercise programs: a systematic review

Marina B. Pinheiro*, Catherine Sherrington, Kirsten Howard, Patrick Caldwell, Anne Tiedemann, Belinda Wang, Juliana S. Oliveira, Andreia Santos, Fiona C. Bull, Juana F. Willumsen, Zoe A. Michaleff, Sarah Ferguson, Eleesheva Mayo, Nicola J. Fairhall, Adrian E. Bauman, Sarah Norris

*Corresponding author for this work

Research output: Contribution to journalReview articleResearchpeer-review

6 Citations (Scopus)
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To investigate cost-effectiveness and costs of fall prevention exercise programmes for older adults. 


Systematic review

Data sources:

Medline, Embase, Web of Science, Scopus, National Institute for Health Research Economic Evaluation Database, Health Technology Assessment database, Tufts Cost-Effectiveness Analysis Registry, Research Papers in Economics and EconLit (inception to May 2022). 

Eligibility criteria for study selection:

Economic evaluations (trial-based or model-based) and costing studies investigating fall prevention exercise programmes 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. 


31 studies were included. For community-dwelling older adults (21 economic evaluations, 6 costing studies), results ranged from more effective and less costly (dominant) interventions up to an ICER of US$279 802/QALY gained and US$11 986/fall prevented (US$ in 2020). Assuming an arbitrary willingness-to-pay threshold (US$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 (two economic evaluations, two costing studies), ICERs ranged from dominant (low certainty) to US$35/fall prevented (moderate certainty). Overall, intervention costs varied and were poorly reported. 


Most economic evaluations investigated fall prevention exercise programmes for older adults living in the community. There is moderate certainty evidence that fall prevention exercise programmes are likely to be cost-effective. The evidence for older adults living in care facilities is more limited but promising. PROSPERO registration number PROSPERO 2020 CRD42020178023.

Original languageEnglish
Pages (from-to)1353-1365
Number of pages14
JournalBritish Journal of Sports Medicine
Issue number23
Publication statusPublished - 27 Oct 2022
Externally publishedYes


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