THE COST-EFFECTIVENESS OF A MULTIFACTORIAL TARGETED PREVENTION PROGRAM FOR FALLS AMONG COMMUNITY ELDERLY PERSONS

OBJECTIVES. Falls and fall injuries are common-potentially preventable -causes of morbidity, functional decline, and increased health-care us e among elderly persons. The current analyses, performed on data obtai ned as part of a randomized controlled trial conducted within a health maintenance organization, describe the costs of a multifactorial, tar geted prevention program for falls, present total net health-care cost s, estimate the cost per fall prevented, and describe acute fall-relat ed health-care costs. METHODS. The 301 participants were at least 70 y ears of age and possessed at least one of eight targeted risk factors for falling. The 153 participants randomized to the targeted intervent ion (TI) group received a combination of medication adjustment, behavi oral recommendations, and exercises as determined by their baseline as sessment. The 148 participants randomized to the usual care (UC) group received a series of home visits by a social work student. RESULTS. T he mean intervention cost per TI participant was $925 (range $588 to $ 1,346). Total mean health-care costs were approximately $2,000 less in the TI than UC group, whereas median costs were approximately $1,100 higher in the TI than UC group. The TI strategy was unequivocally cost effective when mean costs were used because the intervention was asso ciated with both lowered total health-care costs and fewer total and m edical care falls. In sensitivity analyses, the cost-effectiveness of the TI strategy appeared robust to widely differing assumptions about total health-care costs (25th to 75th percentile of the actual distrib ution) and intervention costs (minimum to maximum costs). In subgroup analyses, the TI strategy showed its strongest effect among individual s al high risk of falling, defined as possession of at least four of t he eight targeted risk factors. CONCLUSIONS. Consideration should be g iven toward incorporating and reimbursing the cost of fall-prevention programs within the usual health care of community-living elderly pers ons, particularly for those persons at high risk for falling.