Table 5 Methodological and evaluative challenges for falls prevention economic modelling
Methodological challenges [Theme #]a | Evaluative challenges [Theme #] |
|---|---|
Capturing non-health outcomes and societal intervention costs • Model should capture social benefits of falls prevention interventions [3–8]. • Model should capture private intervention and transport costs [3–23]. • Model should capture any time opportunity cost to participants and informal caregivers: e.g., due to inconvenient timing or location [3–21]. | Perspective, type of analysis and time horizon • Under CUA, the generic health utility measure such as EQ-5D may not fully capture social benefits of interventions [3–8]; the model should consider broader wellbeing measure (e.g., ICECAP-O [54, 55]) • Societal perspective is likely necessary to capture societal intervention costs [3–23]. • Long time horizons required to capture dynamic trajectories and evaluate system changes incurring large sunk costs (e.g., [1–3]). |
Considering dynamic complexity • Model should incorporate dynamic trajectories of ageing and falls risk influencing older person’s demand and appropriate professional response [1–5]. • Model should capture the dynamic trajectories of variables that delineate vulnerable subgroups (e.g., cognitive status, frailty) [6-1, 6-2, 6-3]. • Model should capture wider health benefits of interventions beyond falls prevention [4-3]. • Model should incorporate seasonal changes in falls risk due to environmental risk factors [5-1]. | Types of intervention scenarios evaluated • Main intervention scenario should incorporate: local eligibility criteria tailored to changing falls risk profile; multiple non-mutually exclusive intervention pathways; external evidence on interventions which have similar characteristics as those preferred by local older persons.b • Intervention costing should incorporate: cost of risk identification; cost of auxiliary implementation strategies; fixed/sunk costs for major system changes; cost of additional resources to achieve full set of positive intervention characteristics; cost of professional training to obtain positive attributes; and funding to sustain intervention over sufficiently long period.c • Additional scenarios conducting value of implementation analyses to evaluate auxiliary implementation strategies [2–6]. • Additional scenarios evaluating intersectoral policies (e.g., environmental interventions [5-1, 5-2]) and earlier life-course preventive interventions [2-1]. |
Considering theories/models of human behaviour based on psychology and sociology • Model should incorporate the health/social motives of older persons that influence demand [1–4] • Model should incorporate sociological and contextual factors that influence falls prevention: cultural factors promoting/weakening communal responsibilities for health promotion and safety [5-1, 5-2, 5-4]; regulatory barriers [5-3]. | |
Considering social determinants of health • Model should incorporate socioeconomic and ethnic/linguistic variables and social isolation as social determinants of health [3–19]. | Analysis of equity and other priority setting criteria • Model should examine equity-efficiency trade-offs in adopting strategies that reduce social inequities of health [3–27] or prioritise other vulnerable groups [4–10]. |