Review | Commissioning recommendations | Research recommendations/implications |
---|---|---|
RCN [17] | • No commissioning recommendation based on systematic review results | •Development of a de novo decision model to inform NICE clinical guideline [17] |
Davis [30] | • “We conclude that single interventions (such as the Otago Exercise Programme) targeted at high-risk groups can prevent the greatest number of falls at the lowest incremental costs.” (p. 89) | • “We recommend that future economic evaluations be guided in part by the checklists available for assessing economic evaluations.” (p. 88) •Development of guideline and checklist for falls prevention economic evaluations [22] |
DJ [34] | •Cost-effective/cost-saving interventions in ‘Good’ quality studies: resistance exercise; Otago exercise; Tai Chi; citywide non-pharmaceutical multifactorial programme • “The existing studies are characterized by huge differences in the methods applied as well as overall quality which limits the comparability and generalizability of the results.” (p. 670) | • “There is a need for… methods adjusted to particular character of health promotion and primary prevention strategies for older population.” (p. 670) |
PHE [31] | •Exercise interventions (p. 39–40): Tai Chi is consistently most cost-effective for mobile older persons; group exercise for women aged 70 + cost-effective; Otago home exercise may be cost-saving with high adherence; other home exercises are not cost-effective •Multifactorial interventions (p. 40): paramedic-implemented protocol that followed NICE guideline was cost-saving and is generalizable to English setting; risk assessment without treatments not cost-effective •HAM likely cost-effective but current evidence not generalizable to English setting (p. 40–41) •Medication review likely cost-effective (p. 41) | •Falls prevention economic model should carefully consider whether the intervention being modelled is appropriate for English setting and given target population (p. 44) •Development of a de novo decision model to inform commissioning of falls prevention by CCGs/local authorities [44] |
Olij [32] | • “Home assessment programs were most cost-effective type of program [based on CUA] for community-dwelling older adults.” (p. 2197) • “Multifactorial programs and other [e.g., exercise] programs were less favourable [based on CUA].” (p. 2202) • “Older populations reported more favourable ICERs… [but] it is not possible to draw firm conclusions about age differences.” (p. 2202) • “Methodological differences between studies hampered direct comparison of the cost-effectiveness of program types.” (p. 2197) | • “Future economic evaluations of falls prevention should be designed, conducted, and reported in accordance with current guidelines for economic evaluations to increase comparability.” (p. 2202) • “Future studies should clearly report whether they target high-risk, low-risk, or mixed populations because the baseline fall risk is an important determinant of cost-effectiveness.” (p. 2202) •Models should directly compare different falls intervention types (p. 2202) |
Huter [35] | • “A comparison of results of different economic evaluations, even of similar interventions, has to be carried out with great caution.” (p. 8) • “A comparison of the cost-effectiveness results with… other age groups is not possible and therefore not advisable.” (p. 9) | • “Disregarding [the four featuresa] could implicitly lead to a discrimination of health promotion and disease prevention against older people.” (p. 9) • “More research is necessary on the different approaches for [the four features’] inclusion and on their respective effects on the outcomes.” (p. 9) |
Winser [33] | • “A tailored exercise program including strengthening of lower extremities, balance training, cardiovascular exercise, stretching and functional training of moderate intensity performed twice per week with each session lasting 60 min for 6 or more months delivered in groups of 3 to 8 participants [by PT or nurse trained by PT] with home-based follow-up appears to be cost-effective in preventing falls in older people.” (p. 69) • “Exercise-only programs were more cost-effective than multifactorial falls prevention programs.” But “there were not enough studies of each to draw firm conclusions.” (p. 75, 78) | • “We recommend future studies to test the benefits of adding scheduled walking to the falls prevention exercise protocol.” (p. 76) • “Research is needed to evaluate the efficacy of [group-based learning and home-based practice] programs, in particular in comparison to other programs that may require more resources.” (p. 76) • “Further research is needed… in developing and underdeveloped countries.” (p. 69) • “Future research is needed to systematically compare [exercise-only and multifactorial programs].” (p. 78) |