Elsevier

Public Health

Volume 120, Issue 8, August 2006, Pages 742-751
Public Health

Original Research
Economic analysis of a community-based falls prevention program

https://doi.org/10.1016/j.puhe.2006.04.011Get rights and content

Summary

Objectives

To undertake a cost–benefit analysis of ‘Stay on Your Feet’, a community-based falls prevention program targeting older people at all levels of risk in New South Wales, Australia. Hospital separations were monitored in the intervention region, a control region and for the state of New South Wales as a whole. Changing admission patterns over the intervention period were used to assess the impact of the program.

Methods

Cost–benefit analysis compared the costs of the program with two estimates of savings from avoided hospital admissions. The first compared the cost of hospital admissions in the intervention region to a control region of similar demographics, while the second compared hospital utilization in the intervention region with the state of New South Wales as a whole using falls-related hospital diagnosis related group (DRG) codes.

Results

The total direct costs of the program were estimated at A$781 829. Both methods identified clear overall net benefits ranging from A$5.4 million for avoided hospitalizations alone to A$16.9 million for all avoided direct and indirect costs. The confidence intervals around these estimates were small. The average overall benefit to cost ratio for the intervention as a whole was 20.6:1.

Conclusions

These findings suggest that well-designed community-based interventions targeting falls prevention among older people are highly cost effective and a wise investment for all levels of government. The models used are conservative and are likely to underestimate the real benefit of the intervention, which may have lasted for some time beyond the life of the program.

Introduction

In developed countries, falls are the major cause of unintentional injury among people aged 65 years and older, with approximately 30% of the older adult population experiencing a fall each year.1 Not only are falls among older people associated with a range of complications such as fractures, but repeated falls are also associated with increased functional disability.2 This can lead to higher levels of dependency and care, making falls a strong predictor of institutionalization.3 The relative ageing of populations in developed countries is likely to see the costs associated with falls increase dramatically over the next 20 years. Cost-effective interventions to prevent falls are therefore potentially an attractive investment for health services wishing to reduce preventable demand on clinical resources.

A number of strategies are known to reduce the incidence of falls among older people. These include increasing physical activity and balance, reviewing medication use to minimize side-effects such as postural hypotension, home modifications such as safety rails, and encouraging the use of appropriate eye-ware. 4 However, few studies have examined the effectiveness of falls prevention strategies targeting multiple risk factors across the general older community. There is also little evidence on the economic implications of either targeted or community-based interventions.

This paper reports the economic analysis of ‘Stay on Your Feet’ (SOYF), a community-based falls prevention program targeting older people at all levels of risk. SOYF was undertaken during the period 1992 to 1996 in the North Coast region of New South Wales (NSW), Australia. At this time the region had a population of approximately 400 000, including approximately 90 000 people aged over 60 years. The area ranges from large regional centres to small, remote rural communities. The program comprised a multi-strategic, community-based intervention targeting all people aged over 60 years and living independently. It placed an emphasis on the involvement of older people and has been described in detail elsewhere.5

Initial evaluation of SOYF included prospective analysis of a representative sample of 2000 older people within the intervention region, and comparison with a similar cohort of 1600 older people living in the Sunshine Coast region of the state of Queensland. This region was selected because of its demographic and geographic similarity to the intervention region, and because there were no existing or planned falls prevention activities.6 A number of cross-sectional telephone surveys were also undertaken and revealed significant changes at a population level in awareness and self-reported behaviour within 18 months of the program commencing. This was maintained throughout the life of the program and was followed by a non-significant reduction in the number of self-reported falls. These changes were accompanied by a statistically significant 20% reduction in falls-related hospital admissions in subjects over 60 years of age at the completion of the program, compared with both the control community and the state of New South Wales as a whole.7 This occurred despite the intervention not targeting or involving hospital-based staff.

Since this evaluation, SOYF strategies have been adopted as the basis for major health promotion interventions in other states of Australia, New Zealand and Canada.

Section snippets

Methods

A cost–benefit analysis was used to evaluate the program. This enables health services and governments to compare the return on their investment in SOYF with other possible uses of the health dollar. Two approaches were used.

Method one: A cost–benefit analysis was constructed based on hospital admissions rates in the intervention region compared to the interstate control region used in the initial SOYF evaluation.


Method two: Hospital utilization within the intervention region, as measured by

Estimation of the costs

Direct program costs are shown in Table 1. General infrastructure and management costs have been included as SOYF overheads. The allocation of overheads to SOYF distribution was determined by the proportional size of the SOYF program relative to total activity as measured by dollars spent.16 The annual SOYF costs including overheads were summed and converted to 1995/96 dollars using an 8% discount rate. The estimated cost was A$781 829.

In addition to public costs, private costs associated with

Discussion

These results suggest that the Stay on Your Feet program was highly cost effective in preventing falls among older people. Our two estimates are consistent, although the approach used in method two was more conservative than method one. These results are also generally consistent with the findings of the earlier evaluation of SOYF.7 The confidence interval around our estimates is small, and when the upper confidence limit for the intervention SCR is used in method two, the total estimated

Acknowledgements

The team would like to acknowledge the role of Anne Kempton and Everald Garner in developing and implementing the Stay on Your Feet Program. Without their vision and determination many more people would have suffered the consequences of preventable falls. Liz Patterson and Elizabeth Eakin also contributed significantly to the program's more recent reinvigoration. We would also like to thank Therese Dunn and Vesna Dunne for their help with the calculations used in method one and to thank Gary

References (21)

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