Kwon, J. orcid.org/0000-0002-2860-7280, Squires, H. orcid.org/0000-0002-2776-4014 and Young, T. (2025) Efficiency and equity of community-based falls prevention pathways: a model-based health economic evaluation. Age and Ageing, 54 (8). afaf212. ISSN: 0002-0729
Abstract
Background
Three pathways exist for community-based falls prevention: reactive (R), after a fall requiring medical attention; proactive (P), after professional referral of high-risk individuals; and self-referred (SR), voluntary intervention enrolment. The UK guidelines recommend scale-up of all three [‘recommended care’ (RC)], but scale-up of none [‘usual care’ (UC)], one (R, P, SR) or two (R+P, R+SR, P+SR) are potential options. This study aims to compare the options in terms of efficiency and equity.
Methods
Cost-utility analysis from the societal perspective over a 40-year horizon identified the optimal strategy based on efficiency alone. Probabilistic sensitivity analysis accounted for parameter uncertainty. Efficiency and equity were jointly evaluated by distributional cost-effectiveness analysis. Alternative scenarios assessed changes in frailty, cognitive impairment, intervention demand and GP access.
Results
Public sector cost-effectiveness threshold would need to exceed £30 000 per quality-adjusted life year (QALY) gained for RC to have the highest probability of being cost-effective. R and R+SR were cost-effective, with costs per QALY gained of £2365 (R versus UC) and £5516 (R+SR versus R). RC was cost-ineffective, incurring £34 258 per QALY gained versus R+SR. Other strategies were dominated. However, if decision-makers had the same relative health inequality aversion level as the English general public, RC was optimal in terms of efficiency and equity at threshold of £30 000 per QALY gained. Scenarios of worse geriatric health favoured RC.
Conclusions
Both efficiency and relative health inequality need to be considered for the UK guideline-recommended falls prevention to be optimal versus other permutations of community-based strategies.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Author(s) 2025. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
Keywords: | falls prevention; economic model; NICE falls prevention guideline; equity; older people |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 07 Aug 2025 08:58 |
Last Modified: | 07 Aug 2025 08:58 |
Status: | Published |
Publisher: | Oxford University Press (OUP) |
Refereed: | Yes |
Identification Number: | 10.1093/ageing/afaf212 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:230019 |