Table 5 Characteristics and results of lifetime modelling studies identified by included systematic reviews

Church (2012) [46]

CEA/CUA; Public healthcare

Australian CD adults aged 65 + 

Data source: literature; expert opinion Fall type: non-MA fall; MA fall; hip fracture; fear of falling; fatal fall Economic: ED; inpatient; rehab.; LTC

Type: (i) General – Group exercise; Home exercise; Tai Chi; Multi-component int.; Multifactorial int.; Multifactorial risk assessment; (ii) High-risk – Group exercise; HAM; Multifactorial int.; (iii) Specific – Expedited cataract surgery; Cardiac pacing; Psychotropics withdrawal Comparator: UC; Cross comparisons Resource/cost: Per-participant cost only Implementation: 1-year maintenance^b

Ratios: (i) General – Tai Chi ICER £27,734 per QALY vs. UC; other interventions dominated; (ii) High-risk – Group exercise ICER £31,957 per QALY vs. UC; HAM ICER £36,298 per QALY vs. UC; Multifactorial int. dominated; (iii) Specific – Expedited cataract surgery dominated UC and other interventions. Aggregate: reports incremental cost, no. of falls avoided and QALY gain per intervention, but all interventions have same reach^c (including those targeting high-risk and specific subgroups), and hence cannot compare aggregate impacts. Parameter uncertainty: CEAC; one-way sensitivity analyses on ICER Scenario analyses: No fear of falling had substantial impact

Unclear falls risk progression;^d Recurrent falls not characterised;^e Unclear intervention reach;^c Unclear how high-risk subgroup identified; Mismatch between falls incidence and efficacy metrics; No fixed int. cost; No capacity constraints

Farag (2015) [42]

CUA; Public healthcare

Australian CD adults aged 65 + without prior fall

Data source: literature Fall type: non-MA fall; MA fall; fatal fall Economic: ED; inpatient; LTC

Type: Non-specific falls prevention int. with relative risk of 0.75 and per-participant cost of £420 Comparator: UC Resource/cost: Per-participant cost only Implementation: 50% uptake in base case; maintenance not stated

Ratios: ICER of £17,320 per QALY vs. UC Aggregate: incremental cost and QALY gain outcomes per person can be scaled up but unclear to what extent. Parameter uncertainty: CEAC; 57% probability of being cost-effective at AUS$50,000 threshold; one-way sensitivity analyses on ICER Scenario analyses: e.g., variation in uptake rate had little impact on ICER

Unclear falls risk progression;^d Recurrent falls not characterised;^e No discounting; No fixed int. cost; No capacity constraints

Johansson (2008) [40]

CUA; Societal

Swedish CD adults aged 65 + (n = 5,500)

Data source: int. study Fall type: hip fracture; excess mortality Economic: primary care; inpatient; outpatient; pharma.; LTC; informal care; productivity loss; comorbidity net consumption cost (in scenario)

Type: Multifactorial and environmental int.^f Comparator: UC Resource/cost: Reports total int. cost; Includes cost of stakeholder involvement, volunteer labour and time opportunity cost Implementation: not stated

Ratio: intervention had higher health gain and lower cost (dominated) comparator Aggregate: total int. cost of £640,918; total costs savings of £647,970; total QALY gain of 35.16 Parameter uncertainty: Scatter plot Scenario analyses: Intervention dominated UC for age groups 65–79 and 80 + by sex. Scenarios that made intervention no longer dominant – doubled fracture risk; lower treatment cost of fracture; inclusion of comorbidity net consumption cost;^g higher discount rate; no health/cost consequences of fracture beyond 1^st year; 25% rise in int. cost

Unclear falls risk progression;^d Quasi-experimental study for effectiveness evidence; No tiered threshold for evaluating societal outcomes;^h Internal and external validation conducted

OMAS (2008) [47]

CEA/ROI; Public healthcare

Canadian CD adults aged 65 + 

Data source: routine data analysis Fall type: MA fall; excess mortality Economic: ED; inpatient; rehab.; LTC

Type: Exercise; HAM; Vitamin D & calcium; Psychotropics withdrawal; Gait stabilizing device; Eligibility for each intervention defined by relevant falls risk factor Comparator: UC Resource/cost: Per-participant cost only Implementation: Unique uptake and adherence rates for each intervention; Permanent maintenance for 1^st year adherers

Ratio: All interventions dominated UC under CEA for men and women Aggregate: Reports net cost saving per person which can be scaled up to total for each intervention subgroup at regional level Parameter uncertainty: No analysis Scenario analyses: No analysis

Unclear falls risk progression;^d Recurrent falls not characterised;^e Mismatch between intervention need and falls risk;ⁱ Parameter uncertainty not assessed

Pega (2016) [48]

CUA; Public healthcare

New Zealand CD adults aged 65 + 

Data source: routine data analysis Fall type: indoor MA fall; fatal fall Economic: primary care; pharma.; rehab.; inpatient; comorbidity healthcare cost^j

Type: HAM Comparator: UC Resource/cost: Per-participant cost only Implementation: One-off HAM yields lifetime efficacy (10 years in scenario)

Ratio: HAM had ICER of £5,123 per QALY vs. UC in base case Aggregate: For base case, total int. cost was £82.5 million, total net cost vs. UC £62.6 million and total QALY gain 34,000. Parameter uncertainty: 95% uncertainty interval for ICER between below zero to £11,385 per QALY; one-way sensitivity analyses Scenario analyses: For secondary prevention scenario,^k ICER was £1,139 per QALY, total int. cost £10.2 million, total net cost vs. UC, £3.5 million, and total QALY gain 20,100. Targeting those aged 75 + produced ICER of £8,956 per QALY, total net cost vs. UC £31.1 million, and total QALY gain 8,750. Subgroup analyses showed higher ICERs for Maori and men. Equity analyses showed that the higher ICERs can be mainly attributed to shorter life expectancies of Maori and men

Unclear falls risk progression;^d Recurrent falls not characterised;^e Routine data lacks individual identifier;^l No background transition in health utilities; No fixed int. cost; No capacity constraints; No scenario estimating efficiency cost^m