Economic evaluation of multiple falls prevention interventions among community-residing older adults: we know the ‘value’, but what about ‘value for money’?
Bibliographic record
Abstract
INTRODUCTION: Falls among older adults are a substantial concern, with considerable effects on health, service use and costs. Preventing falls is therefore an important goal. In our previous systematic review and network meta-analysis (NMA), several effective fall prevention interventions were identified, but their cost-effectiveness in Canada remains unknown. METHODS: A microsimulation model was used to conduct a cost-utility analysis from a public healthcare payer perspective and a lifetime time horizon. Data sources included the previous NMA, administrative datasets and published literature. Three interventions (exercise, exercise plus vision assessment [Ex + va], and Ex + va + environmental assessment) were compared to usual care in the primary analysis; a secondary analysis assessed four additional interventions. Uncertainty was characterised in scenario analyses. RESULTS: Ex + va had the lowest cost ($149 346, 95% confidence interval [CI] 147 985-150 706) and the highest quality-adjusted life years (QALYs) gained (7.35, 95% CI 7.34-7.37), dominating all other interventions. Differences in costs and QALYs between interventions were small (ranges: $149 346-152 691; 7.27-7.35); usual care was the costliest and least effective. Results were unchanged in the scenario analyses. DISCUSSION: Ex + va dominated all other interventions, and all primary interventions dominated usual care. Adoption of a societal perspective may affect these conclusions, as some costs for vision care and environmental modifications are borne by patients in our setting, which were not included. Uptake of interventions that reduce falls and costs is recommended. These findings demonstrate that in Canada, multiple forms of fall prevention interventions may reduce costs and improve outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.034 | 0.099 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.010 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".