Economic models of community-based falls prevention: a systematic review with subsequent commissioning and methodological recommendations

Kwon, Joseph; Squires, Hazel; Franklin, Matthew; Lee, Yujin; Young, Tracey

doi:10.1186/s12913-022-07647-6

Table 2 Overview and quality score of included falls prevention decision models

From: Economic models of community-based falls prevention: a systematic review with subsequent commissioning and methodological recommendations

#	Reference	Setting	Target population	Type of analysis	Perspective	Intervention type	Comparator	Model type	Time horizon
1	Agartioglu (2020) [50]	Turkey, Izmir	CD adults aged 65+	CEA	Public sector	HAM	UC	DT	1 year
2	Albert (2016) [51]	US, Pennsylvania	CD adults aged 50+ (mean age 75.5)	CUA	Public sector	MF int.	UC	DT	1 year
3	Alhambra-Borras (2019) [52]	Spain, Valencia, hospital level	CD adults aged 65+ at high falls risk or frail with no severe physical or cognitive limitation	CUA	Public sector	Exercise	UC	Markov cohort^a	Lifetime
4	Beard (2006) [53]	Australia, NSW	CD adults aged 60+	CBA; ROI	Public sector; Societal	MC (intersectoral) int.^b	UC	Binary decision^c	5 years
5	Boyd (2020) [54]	New Zealand	Adults aged 65+	CUA	Public sector	Cataract surgery (expedited, routine)	NR	Markov cohort	Lifetime
6	Carande-Kulis (2015) [55]	US, private insurers	CD adults aged 65+	ROI	US health insurance payer	Exercise (2 forms); MC int. (Stepping On)	NR	Binary decision	1 year
7	CSP (2016) [56]	UK, varying regions	CD adults aged 65+	ROI	Public sector	FRS + Exercise (physiotherapy)	NR	DT	1 year
8	Church (2011) [57]	Australia, NSW	CD adults aged 65+ (separate model for residential care)	CEA; CUA	Public sector	Exercise (3 forms); MC int.; MF int.; MRA; Exp. cataract surgery; Med. modification; Cardiac pacing	NR	Markov cohort	10 years
9	Church (2012) [58]	Australia, NSW	CD adults aged 65+	CEA; CUA	Public sector	Exercise (4 forms); MC int.; MF int. (2 forms); MRA; HAM; Exp. cataract surgery; Cardiac pacing; Med. modification	NR; Cross-comparison	Markov cohort	Lifetime
10	Comans (2009) [59]	Australia, Brisbane	CD adults aged 65+, falls history in past 6 months or gait/functional decline and cognitively intact	ROI	Societal	MF int. (2 forms)	NR	Binary decision	1 year
11	Day (2009) [60]	Australia, varying regions	CD adults aged 50+ (age and characteristics differ by intervention type)^d	CEA	Public sector; Societal	Exercise (2 forms); HAM; MF int.; Med. modification; Cardiac pacing	NR	DT	1 year
12	Day (2010) [61]	Australia	CD adults aged 70+	CEA	Public sector; Societal	Exercise (Tai Chi)	NR	DT	1 year
13	Deverall (2018) [62]	New Zealand	CD adults aged 65+	CUA	Public sector; Societal	Exercise (3 forms)	NR	Markov cohort	25 years
14	Eldridge (2005) [63]	UK, primary care trust	Adults aged 65+ in community or nursing home	CUA	Public sector	FRS + MF int. or Exercise	UC	DT + Markov cohort	Lifetime
15	Farag (2015) [64]	Australia	CD adults aged 65+ without falls history	CUA	Public sector	Non-specific intervention	NR	Markov cohort	Lifetime
16	Franklin (2019) [65]	UK, city level	CD adults aged 65+	CUA	Public sector (2 types)	FRS + Exercise (3 forms) or HAM	NR; Cross-comparison	DT + Markov cohort	2 years
17	Frick (2010) [66]	US	CD adults aged 65+	CUA	US healthcare payer^e	Exercise (2 forms); HAM; MF int. (2 forms); Vit. D; Med. modification	Cross-comparison	Binary decision	1 year^f
18	Hektoen (2009) [67]	Norway	CD women aged 80+	CEA	Societal	Exercise	NR	Binary decision	1 year
19	Hiligsmann (2014) [68]	Belgium	Adults aged 60+ with osteoporosis	CUA	Societal	Vit. D and calcium	NR	Markov patient^a	Lifetime
20	Hirst (2016) [69]	UK	Women aged 75+ on chronic pain medication	CUA	Public sector	Med. modification (Transdermal Buprenorphine)	Tramadol	DT^g	1 year
21	Honkanen (2006) [70]	US, Medicare/aid	Adults aged 65+ living in community at baseline	CUA; ROI	Societal	Hip protectors	NR	Markov cohort	Lifetime
22	Howland (2015) [71]	US, Massachusetts	CD adults aged 65+ admitted to A&E due to fall	ROI	US healthcare payer^e	MC int. (MoB/VLL)	NR	Binary decision	1 year
23	Ippoliti (2018) [72]	Italy, Piedmont	CD adults aged 65+ living in mountainous areas	ROI	Public sector	MF int.	NR	Binary decision	3 years
24	Johansson (2008) [73]	Sweden, Stockholm	CD adults aged 65+	CUA	Societal	MC (intersectoral) int.^h	UC	Markov cohort	Lifetime
25	Lee (2013) [74]	US, Medicare/aid	CD adults aged 65–80 without falls history	CBA	Public sector	Vit. D (targeted, universal)	NR	DT + Markov cohort	3 years
26	Ling (2008) [75]	US, Hawaii	CD adults aged 65+ with falls history or other risk factors	ROI	US healthcare payer^e	HAM	NR	Binary decision	1 year
27	McLean (2015) [76]	Australia, Melbourne	CD adults aged 70+	CEA; CUA	Public sector	Exercise	UC	DT	18 months
28	Miller (2011) [77]	US, Texas	CD adults aged 50+ at high falls risk	ROI	US healthcare;^e Societal	MC int. (MoB/VLL)	NR	Binary decision	2 years
29	Mori (2017) [78]	US	CD women aged 65+ at osteoporosis risk without previous fracture	CUA	Societal	Exercise and bisphosphonate combined	Cross-comparison: single or no intervention	DT + Markov patient	Lifetime
30	Moriarty (2019) [79]	Ireland	CD adults aged 65, no current/previous adverse events for benzodiazepine/PPI	CUA	Public sector	Med. modification (Benzodiazepine, PPIn)	Inappropriate prescribing	DT + Markov patient	35 years
31	Nshimyu-mukiza (2013) [80]	Canada	Women aged 40+ (with subgroup aged 65+)	CEA; CUA	Public sector	Fracture risk screening + Physical activity, Vit. D and calcium, and/or Osteoporosis screen & treat	NR; Cross-comparison	DT + Markov patient	Lifetime
32	OMAS (2008) [81]	Canada, Ontario	CD adults aged 65+	CEA; ROI	Public sector	Exercise; HAM; Vit. D and calcium; Med. modification; gait-stabilizer	NR	Markov cohort	Lifetime
33	Pega (2016) [82]	New Zealand	CD adults aged 65+	CUA	Public sector	HAM	NR	Markov cohort	Lifetime
34	Poole (2014) [83]	UK	Adults aged 65+	ROI	Public sector	Vit. D	NR	Binary decision	1 year
35	Poole (2015) [84]	UK	CD adults aged 60+	CUA; ROI	Public sector	Vit. D	NR	Markov cohort	5 years
36	PHE (2018) [85]	England, varying regions	CD adults aged 65+	CUA; ROI	Public sector	Exercise (3 forms); HAM	NR	DT	2 years
37	RCN (2005) [34]	England & Wales	CD adults aged 60+	CUA	Public sector	Exercise; MF int.	NR	Markov cohort	Lifetime
38	Sach (2007) [86]	UK	Women aged 70+ with bilateral cataracts	CEA; CUA	Public sector; Societal	Exp. cataract surgery (first eye)	UC (routine surgery)	Binary decision	Lifetime extrapol.ⁱ
39	Sach (2010) [87]	UK	Women aged 70+ with second operable cataract	CUA	Public sector; Societal	Exp. cataract surgery (second eye)	UC (no surgery)	Binary decision	Lifetime extrapol.ⁱ
40	Smith (2016) [88]	UK, NW London	Adults aged 65+ covered by GP practice and hospital	ROI	Public sector	FRS + MF int.	Cross-comparison	Risk prediction	1 year
41	Tannenbaum (2015) [89]	US, Medicare/aid	CD adults aged 65+ with insomnia	CUA	Public sector	Med. modification; CBT	NR; Cross-comparison	Markov cohort	1 year
42	Turner (2020) [90]	Canada, Quebec	CD adults aged 65+ who are chronic users of sedatives for insomnia	CUA	Public sector	Med. modification	NR	DT + Markov cohort	1 year
43	Velde (2008) [91]	Netherlands	CD geriatric outpatient population with falls history (mean age 78)	CEA	Public sector	Med. modification	NR	Binary decision	1 year^f
44	Wilson (2017) [92]	New Zealand, Manukau	CD adults aged 65+	CUA	Public sector	HAM	NR	Markov cohort	Lifetime
45	Wu (2010) [93]	US, Medicare/aid	CD Medicare beneficiaries aged 65+ with falls history	CEA; ROI	Public sector; Societal	MF int.	NR	Binary decision	1 year
46	Zarca (2014) [94]	France	Adults aged 65+ without previous hip fracture	CEA; CUA	Public sector	Vit. D (targeted (2), universal)	NR; Cross-comparison	DT + Markov patient	Lifetime

Abbreviations: CBA Cost-benefit analysis, CBT Cognitive behavioural therapy, CD Community-dwelling, CEA Cost-effectiveness analysis, CSP Chartered Society of Physiotherapy, CUA Cost-utility analysis, DT Decision tree, Exp. Expedited, Extrapol. Extrapolated, FRS Falls risk screening, HAM Home assessment and modification, Int. Intervention, MC Multiple-component, Med. Medication, MF Multifactorial, MoB/VLL Matter of Balance Lay-Led Version, MRA Multifactorial risk assessment only, NR Non-receipt of modelled intervention(s), NSW New South Wales, OMAS Ontario Medical Advisory Secretariat, PHE Public Health England, PPIn Proton pump inhibitor, RCN Royal College of Nursing, ROI Return on investment analysis, UC Usual care
^a“Markov cohort” describes cohort-level Markov models that simulate the proportion of a population that experience an event (e.g., fall incidence) and progresses to a different model state. “Markov patient” describes patient- or individual-level Markov models that simulate the progression of individuals with unique set of characteristics [95]
^bIntervention included individually tailored education, HAM and exercise and public space safety improvement
^cBinary decision models include two scenarios, with or without intervention, and no time-based cycles or probability trees
^dCardiac pacing targeted population aged 50+ due to their high falls risk. Other interventions targeted populations aged 65+
^eThis would include Medicare/aid, private health insurance and patients
^fOne-year horizon with lifetime costs and health effects of falls
^gAuthors described the model as microsimulation; but there was only a single one-year cycle. Hence, the model is classified as a decision tree
^hIntervention included individually tailored education, group balance exercises, Tai Chi, other physical activities and HAM, neighbourhood hazard removal and housing reconstruction
ⁱOne-year trial outcomes are extrapolated over lifetime horizon

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