Is it cost-effective to prevent falls in the elderly?

Yes, according to researchers at Johns Hopkins University, in Baltimore, Maryland whose findings are based on a mathematical epidemiological model.

First, the details.

• No humans were involved in the study.
• The last Cochrane database review categorized effective fall-prevention interventions.
  • Medical management (withdrawal) of psychotropics
  • Group tai chi
  • Vitamin D supplementation
  • Muscle and balance exercises
  • Home modifications
  • Multifactorial individualized programs for all elderly people
  • Multifactorial individualized treatments for high-risk frail elderly people
• Fall-related hip fracture incidence was obtained from the literature.
• Salary for health professionals were based on Bureau of Labor Statistics data.
• Healthcare costs were estimated based on practice and studies on falls in older adults.
• Cost utility ratios were calculated, and probabilistic sensitivity analyses were conducted.

And, the results.

• Least-costly, most-effective options
  • Medical management of psychotropics and group tai chi
    • They were also the least studied.
• Other least-expensive, most-effective options
  • Vitamin D supplementation and home modifications
  • Vitamin D costs less than home modifications, but home modifications cost only $14,794/QALY gained more than vitamin D.
    • QALY (quality-adjusted life year) is a year of life adjusted for its quality or value.
• Excluding management of psychotropics and tai chi, home modification is most likely to have the highest economic benefit when QALYs are valued at $50,000 or $100,000.

The bottom line?

Among the individual treatment options, managing psychotropic drug therapy and tai chi reduces costs the most, but require more study for confirmation. Based on the greatest evidence, home modifications provide the best value.

3/15/10 23:38 JR