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Published in: Osteoporosis International 9/2011

01-09-2011 | Original Article

Guidelines for conducting and reporting economic evaluation of fall prevention strategies

Authors: J. C. Davis, M. C. Robertson, T. Comans, P. A. Scuffham

Published in: Osteoporosis International | Issue 9/2011

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Abstract

Summary

Falls in older people result in substantial health burden. Compelling evidence indicates that falls can be prevented. We developed comprehensive guidelines for economic evaluations of fall prevention interventions to facilitate publication of high-quality economic evaluations of the effective strategies and aid decision making.

Introduction

The importance of economics applied to falls and fall prevention in older people has largely been overlooked. The use of different methodologies to assess the costs and health benefits of the interventions and their comparators and the inconsistent reporting in the studies limits the usefulness of these economic evaluations for decision making. We developed guidelines to encourage and facilitate completion of high-quality economic evaluations of effective fall prevention strategies.

Methods

We used a generic checklist for economic evaluations as a platform to develop comprehensive guidelines for conducting and reporting economic evaluations of fall prevention strategies. We considered the many challenges involved, particularly in identifying, measuring, and valuing the relevant cost items.

Results

We recommend researchers include cost outcomes and report incremental cost-effectiveness ratios in terms of falls prevented and quality adjusted life years in all clinical trials of fall prevention interventions. Studies should include the following cost categories: (1) implementing the intervention, (2) delivering the comparator group intervention, (3) total health care costs, (4) costs of fall-related health care resource use, and (5) personal and informal carer opportunity costs.

Conclusions

This paper provides a timely benchmark to promote comparability and consistency for conducting and reporting economic evaluations of fall prevention strategies.
Literature
1.
go back to reference Campbell AJ, Borrie MJ, Spears GF (1989) Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 44:M112–M117PubMed Campbell AJ, Borrie MJ, Spears GF (1989) Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 44:M112–M117PubMed
2.
go back to reference Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707PubMedCrossRef Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707PubMedCrossRef
3.
go back to reference Campbell AJ, Borrie MJ, Spears GF, Jackson SL, Brown JS, Fitzgerald JL (1990) Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing 19:136–141PubMedCrossRef Campbell AJ, Borrie MJ, Spears GF, Jackson SL, Brown JS, Fitzgerald JL (1990) Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing 19:136–141PubMedCrossRef
4.
go back to reference Corso P, Finkelstein E, Miller T, Fiebelkorn I, Zaloshnja E (2006) Incidence and lifetime costs of injuries in the United States. Inj Prev 12:212–218PubMedCrossRef Corso P, Finkelstein E, Miller T, Fiebelkorn I, Zaloshnja E (2006) Incidence and lifetime costs of injuries in the United States. Inj Prev 12:212–218PubMedCrossRef
5.
go back to reference Wong RY, Miller WC (2008) Adverse outcomes following hospitalization in acutely ill older patients. BMC Geriatr 8:10PubMedCrossRef Wong RY, Miller WC (2008) Adverse outcomes following hospitalization in acutely ill older patients. BMC Geriatr 8:10PubMedCrossRef
6.
go back to reference Iglesias CP, Manca A, Torgerson DJ (2009) The health-related quality of life and cost implications of falls in elderly women. Osteoporos Int 20:869–878PubMedCrossRef Iglesias CP, Manca A, Torgerson DJ (2009) The health-related quality of life and cost implications of falls in elderly women. Osteoporos Int 20:869–878PubMedCrossRef
7.
go back to reference Stel VS, Pluijm SM, Deeg DJ, Smit JH, Bouter LM, Lips P (2004) Functional limitations and poor physical performance as independent risk factors for self-reported fractures in older persons. Osteoporos Int 15:742–750PubMedCrossRef Stel VS, Pluijm SM, Deeg DJ, Smit JH, Bouter LM, Lips P (2004) Functional limitations and poor physical performance as independent risk factors for self-reported fractures in older persons. Osteoporos Int 15:742–750PubMedCrossRef
8.
go back to reference Scuffham P, Chaplin S, Legood R (2003) Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health 57:740–744PubMedCrossRef Scuffham P, Chaplin S, Legood R (2003) Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health 57:740–744PubMedCrossRef
9.
go back to reference Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG (1994) Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist 34:16–23PubMedCrossRef Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG (1994) Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist 34:16–23PubMedCrossRef
10.
go back to reference Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. Issue 2. Art. No.: CD007146. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. Issue 2. Art. No.: CD007146.
11.
go back to reference Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA (2010) Does a home-based strength and balance programme in people aged ≥80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions. Br J Sports Med 44:80–89PubMedCrossRef Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA (2010) Does a home-based strength and balance programme in people aged ≥80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions. Br J Sports Med 44:80–89PubMedCrossRef
12.
go back to reference Davis JC, Marra CA, Robertson MC, Khan KM, Najafzadeh M, Ashe MC, Liu-Ambrose T (2010) Economic evaluation of dose-response resistance training in older women: a cost-effectiveness and cost-utility analysis. Osteoporos Int. doi: 10.1007/s00198-010-1356-5 Davis JC, Marra CA, Robertson MC, Khan KM, Najafzadeh M, Ashe MC, Liu-Ambrose T (2010) Economic evaluation of dose-response resistance training in older women: a cost-effectiveness and cost-utility analysis. Osteoporos Int. doi: 10.​1007/​s00198-010-1356-5
13.
go back to reference Drummond MF, Sculpher MJ, Torrance GW, O’Brien B, Stoddart GL (2005) Methods for the economic evaluation for health care programmes, 3rd edn. Oxford University Press, New York Drummond MF, Sculpher MJ, Torrance GW, O’Brien B, Stoddart GL (2005) Methods for the economic evaluation for health care programmes, 3rd edn. Oxford University Press, New York
14.
go back to reference Beard J, Rowell D, Scott D, van Beurden E, Barnett L, Hughes K, Newman B (2006) Economic analysis of a community-based falls prevention program. Public Health 120:742–751PubMedCrossRef Beard J, Rowell D, Scott D, van Beurden E, Barnett L, Hughes K, Newman B (2006) Economic analysis of a community-based falls prevention program. Public Health 120:742–751PubMedCrossRef
15.
go back to reference Stevens JA, Corso PS, Finkelstein EA, Miller TR (2006) The costs of fatal and non-fatal falls among older adults. Inj Prev 12:290–295PubMedCrossRef Stevens JA, Corso PS, Finkelstein EA, Miller TR (2006) The costs of fatal and non-fatal falls among older adults. Inj Prev 12:290–295PubMedCrossRef
16.
go back to reference Seematter-Bagnoud L, Wietlisbach V, Yersin B, Bula CJ (2006) Healthcare utilization of elderly persons hospitalized after a noninjurious fall in a Swiss academic medical center. J Am Geriatr Soc 54:891–897PubMedCrossRef Seematter-Bagnoud L, Wietlisbach V, Yersin B, Bula CJ (2006) Healthcare utilization of elderly persons hospitalized after a noninjurious fall in a Swiss academic medical center. J Am Geriatr Soc 54:891–897PubMedCrossRef
17.
go back to reference Lamb SE, Jorstad-Stein EC, Hauer K, Becker C (2005) Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus. J Am Geriatr Soc 53:1618–1622PubMedCrossRef Lamb SE, Jorstad-Stein EC, Hauer K, Becker C (2005) Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus. J Am Geriatr Soc 53:1618–1622PubMedCrossRef
18.
go back to reference Guyatt GH, Feeny DH, Patrick DL (1993) Measuring health-related quality of life. Ann Intern Med 118:622–629PubMed Guyatt GH, Feeny DH, Patrick DL (1993) Measuring health-related quality of life. Ann Intern Med 118:622–629PubMed
19.
go back to reference Fitzpatrick R, Davey C, Buxton MJ, Jones DR (1998) Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess 2:1–74, i–ivPubMed Fitzpatrick R, Davey C, Buxton MJ, Jones DR (1998) Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess 2:1–74, i–ivPubMed
20.
go back to reference Marra CA, Woolcott JC, Kopec JA, Shojania K, Offer R, Brazier JE, Esdaile JM, Anis AH (2005) A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Soc Sci Med 60:1571–1582PubMedCrossRef Marra CA, Woolcott JC, Kopec JA, Shojania K, Offer R, Brazier JE, Esdaile JM, Anis AH (2005) A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Soc Sci Med 60:1571–1582PubMedCrossRef
22.
go back to reference Torrance GW (1986) Measurement of health state utilities for economic appraisal. J Health Econ 5:1–30PubMedCrossRef Torrance GW (1986) Measurement of health state utilities for economic appraisal. J Health Econ 5:1–30PubMedCrossRef
23.
go back to reference Torrance GW (1987) Utility approach to measuring health-related quality of life. J Chronic Dis Ther Res 40:593–603CrossRef Torrance GW (1987) Utility approach to measuring health-related quality of life. J Chronic Dis Ther Res 40:593–603CrossRef
24.
go back to reference Brazier J, Roberts J, Deverill M (2002) The estimation of a preference-based measure of health from the SF-36. J Health Econ 21:271–292PubMedCrossRef Brazier J, Roberts J, Deverill M (2002) The estimation of a preference-based measure of health from the SF-36. J Health Econ 21:271–292PubMedCrossRef
25.
go back to reference Horsman J, Furlong W, Feeny D, Torrance G (2003) The Health Utilities Index (HUI): concepts, measurement properties and applications. Health Qual Life Outcomes 1:54PubMedCrossRef Horsman J, Furlong W, Feeny D, Torrance G (2003) The Health Utilities Index (HUI): concepts, measurement properties and applications. Health Qual Life Outcomes 1:54PubMedCrossRef
26.
go back to reference Feeny D, Furlong W, Torrance GW, Goldsmith CH, Zhu Z, DePauw S, Denton M, Boyle M (2002) Multiattribute and single-attribute utility functions for the Health Utilities Index Mark 3 system. Med Care 40:113–128PubMedCrossRef Feeny D, Furlong W, Torrance GW, Goldsmith CH, Zhu Z, DePauw S, Denton M, Boyle M (2002) Multiattribute and single-attribute utility functions for the Health Utilities Index Mark 3 system. Med Care 40:113–128PubMedCrossRef
27.
go back to reference Harwood RH (2008) Economic evaluations of complex services for older people. Age Ageing 37:491–493PubMedCrossRef Harwood RH (2008) Economic evaluations of complex services for older people. Age Ageing 37:491–493PubMedCrossRef
28.
go back to reference Bryan S, Hardyman W, Bentham P, Buckley A, Laight A (2005) Proxy completion of EQ-5D in patients with dementia. Qual Life Res 14:107–118PubMedCrossRef Bryan S, Hardyman W, Bentham P, Buckley A, Laight A (2005) Proxy completion of EQ-5D in patients with dementia. Qual Life Res 14:107–118PubMedCrossRef
29.
go back to reference Sansoni J, Marosszeky N, Jeon Y-H, Chenoweth L, Hawthorne G, King M, Budge M, Zapart S, Sansoni E, Senior K, Kenny P, Low L (2007) Final report: dementia outcomes measurement suite project. Centre for Health Service Development, University of Wollongong, Wollongong Sansoni J, Marosszeky N, Jeon Y-H, Chenoweth L, Hawthorne G, King M, Budge M, Zapart S, Sansoni E, Senior K, Kenny P, Low L (2007) Final report: dementia outcomes measurement suite project. Centre for Health Service Development, University of Wollongong, Wollongong
30.
go back to reference Coast J, Flynn TN, Natarajan L, Sproston K, Lewis J, Louviere JJ, Peters TJ (2008) Valuing the ICECAP capability index for older people. Soc Sci Med 67:874–882PubMedCrossRef Coast J, Flynn TN, Natarajan L, Sproston K, Lewis J, Louviere JJ, Peters TJ (2008) Valuing the ICECAP capability index for older people. Soc Sci Med 67:874–882PubMedCrossRef
31.
go back to reference Coast J, Peters TJ, Natarajan L, Sproston K, Flynn T (2008) An assessment of the construct validity of the descriptive system for the ICECAP capability measure for older people. Qual Life Res 17:967–976PubMedCrossRef Coast J, Peters TJ, Natarajan L, Sproston K, Flynn T (2008) An assessment of the construct validity of the descriptive system for the ICECAP capability measure for older people. Qual Life Res 17:967–976PubMedCrossRef
32.
go back to reference Davis JC (2010) Health economic studies: a focus on health related quality of life, health resource utilization and falls prevention in vulnerable community dwelling seniors in medicine. University of British Columbia, Vancouver Davis JC (2010) Health economic studies: a focus on health related quality of life, health resource utilization and falls prevention in vulnerable community dwelling seniors in medicine. University of British Columbia, Vancouver
33.
go back to reference Glick HA, Doshi JA, Sonnad SA, Polsky D (2007) Economic evaluation in clinical trials. Oxford University Press, New York Glick HA, Doshi JA, Sonnad SA, Polsky D (2007) Economic evaluation in clinical trials. Oxford University Press, New York
34.
go back to reference Oostenbrink JB, Al MJ (2005) The analysis of incomplete cost data due to dropout. Health Econ 14:763–776PubMedCrossRef Oostenbrink JB, Al MJ (2005) The analysis of incomplete cost data due to dropout. Health Econ 14:763–776PubMedCrossRef
35.
go back to reference Manca A, Palmer S (2005) Handling missing data in patient-level cost-effectiveness analysis alongside randomised clinical trials. Appl Health Econ Health Policy 4:65–75PubMedCrossRef Manca A, Palmer S (2005) Handling missing data in patient-level cost-effectiveness analysis alongside randomised clinical trials. Appl Health Econ Health Policy 4:65–75PubMedCrossRef
36.
go back to reference Briggs A, Clark T, Wolstenholme J, Clarke P (2003) Missing... presumed at random: cost-analysis of incomplete data. Health Econ 12:377–392PubMedCrossRef Briggs A, Clark T, Wolstenholme J, Clarke P (2003) Missing... presumed at random: cost-analysis of incomplete data. Health Econ 12:377–392PubMedCrossRef
37.
go back to reference Gardiner JC, Sirbu CM, Rahbar MH (2004) Update on statistical power and sample size assessments for cost-effectiveness studies. Expert Rev Pharmacoecon Outcomes Res 4:89–98PubMedCrossRef Gardiner JC, Sirbu CM, Rahbar MH (2004) Update on statistical power and sample size assessments for cost-effectiveness studies. Expert Rev Pharmacoecon Outcomes Res 4:89–98PubMedCrossRef
38.
go back to reference Briggs AH, Gray AM (1998) Power and sample size calculations for stochastic cost-effectiveness analysis. Med Decis Making 18:S81–S92PubMedCrossRef Briggs AH, Gray AM (1998) Power and sample size calculations for stochastic cost-effectiveness analysis. Med Decis Making 18:S81–S92PubMedCrossRef
39.
go back to reference O’Hagan A, Stevens JW (2002) Bayesian methods for design and analysis of cost-effectiveness trials in the evaluation of health care technologies. Stat Methods Med Res 11:469–490PubMedCrossRef O’Hagan A, Stevens JW (2002) Bayesian methods for design and analysis of cost-effectiveness trials in the evaluation of health care technologies. Stat Methods Med Res 11:469–490PubMedCrossRef
40.
go back to reference Sonnenberg FA, Beck JR (1993) Markov models in medical decision making: a practical guide. Med Decis Making 13:322–338PubMedCrossRef Sonnenberg FA, Beck JR (1993) Markov models in medical decision making: a practical guide. Med Decis Making 13:322–338PubMedCrossRef
41.
go back to reference Bryant T (2002) Role of knowledge in public health and health promotion policy change. Health Promot Int 17:89–98PubMedCrossRef Bryant T (2002) Role of knowledge in public health and health promotion policy change. Health Promot Int 17:89–98PubMedCrossRef
42.
go back to reference Wiseman V, Mooney G (1998) Burden of illness estimates for priority setting: a debate revisited. Health Policy 43:243–251PubMedCrossRef Wiseman V, Mooney G (1998) Burden of illness estimates for priority setting: a debate revisited. Health Policy 43:243–251PubMedCrossRef
43.
go back to reference Mooney G, Irwig L, Leeder S (1997) Priority setting in health care: unburdening from the burden of disease. Aust N Z J Public Health 21:680–681PubMedCrossRef Mooney G, Irwig L, Leeder S (1997) Priority setting in health care: unburdening from the burden of disease. Aust N Z J Public Health 21:680–681PubMedCrossRef
45.
go back to reference Earnshaw J, Lewis G (2008) NICE guide to the methods of technology appraisal: pharmaceutical industry perspective. Pharmacoeconomics 26:725–727PubMedCrossRef Earnshaw J, Lewis G (2008) NICE guide to the methods of technology appraisal: pharmaceutical industry perspective. Pharmacoeconomics 26:725–727PubMedCrossRef
Metadata
Title
Guidelines for conducting and reporting economic evaluation of fall prevention strategies
Authors
J. C. Davis
M. C. Robertson
T. Comans
P. A. Scuffham
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 9/2011
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-010-1482-0

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