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Table 4 Commissioning recommendations and research implications from previous systematic reviews of community-based falls prevention economic evaluations

From: Economic evaluation of community-based falls prevention interventions for older populations: a systematic methodological overview of systematic reviews

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)

  1. Abbreviation: CCG clinical commissioning group, CUA cost-utility analysis, HAM home assessment and modification, NICE National Institute for Health and Care Excellence, PT physiotherapist
  2. aThese are: (i) measurement and valuation of informal caregiving; (ii) accounting for productivity costs (including unpaid work); (iii) accounting for unrelated cost in added life years; and (iv) accounting for wider non-health effects of interventions