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The cost effectiveness of a home hazard reduction program to reduce falls among older persons
G Salkeld1, R G Cumming, E O'Neill
1Department of Public Health and Community Medicine, University of Sydney, New South Wales. glenns@pub.health.usyd.edu.au
Background:
The effectiveness of individual components (other than exercise) of multifactorial intervention packages aimed to reduce the incidence of falls in older people is uncertain. There have been no randomised trials of home modifications alone for the prevention of falls.
Objectives:
To estimate the cost-effectiveness of just one component of a multifactorial approach to falls prevention, that is, a home hazard reduction program. The study estimates the size and direction of change in resource use within and between the hospital, home and community sectors.
Methods:
A randomised trial was conducted to evaluate the effectiveness of home modifications for prevention of falls among older people. An occupational therapist (O/T) with experience in aged care assessed homes for environmental hazards and supervised the necessary home modifications.
Subjects:
The subjects in this study were people aged 65 years and older and most were recruited during a hospital stay. The cost-effectiveness analysis was based on a randomised trial with a total of 530 subjects.
Results:
The incremental cost per fall prevented was $4,986. A sensitivity analysis was conducted by removing 12 outlier subjects (6 control and 6 intervention). The incremental cost per fall prevented was $1,921 for all subjects and was cost saving for subjects who had fallen in the 12 months prior to randomisation.
Conclusions & Implications:
A single factor home hazard reduction program is more likely to be most cost-effective amongst older people who have a history of falls.