TY - JOUR
T1 - Economic evaluations of fall prevention exercise programs: a systematic review
AU - Pinheiro, Marina B.
AU - Sherrington, Catherine
AU - Howard, Kirsten
AU - Caldwell, Patrick
AU - Tiedemann, Anne
AU - Wang, Belinda
AU - Oliveira, Juliana S.
AU - Santos, Andreia
AU - Bull, Fiona C.
AU - Willumsen, Juana F.
AU - Michaleff, Zoe A.
AU - Ferguson, Sarah
AU - Mayo, Eleesheva
AU - Fairhall, Nicola J.
AU - Bauman, Adrian E.
AU - Norris, Sarah
N1 - Funding Information:
This work was prepared for and funded by the Physical Activity Unit, Department of Health Promotion, Division of Universal Health Coverage and Healthier Populations, WHO.
Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/10/27
Y1 - 2022/10/27
N2 - Objective:To investigate cost-effectiveness and costs of fall prevention exercise programmes for older adults. Design:Systematic reviewData 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. Results: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. Conclusions: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.
AB - Objective:To investigate cost-effectiveness and costs of fall prevention exercise programmes for older adults. Design:Systematic reviewData 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. Results: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. Conclusions: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.
UR - https://www.scopus.com/pages/publications/85142402117
U2 - 10.1136/bjsports-2022-105747
DO - 10.1136/bjsports-2022-105747
M3 - Review article
C2 - 36302631
AN - SCOPUS:85142402117
SN - 0306-3674
VL - 56
SP - 1353
EP - 1365
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
IS - 23
ER -