Cost-effectiveness of group-based exercise to prevent falls in elderly community-dwelling people

Background Clinical studies indicate that strength-balance training for active fall prevention can prevent fractures in older people. The present modelling study evaluates the cost-effectiveness of fall prevention exercise (FPE) provided to independently living older people compared to no intervention in Germany. Method We designed a Markov model to evaluate the cost-effectiveness of a group-based FPE-program provided to independently living people >= 75 years from the perspective of the German statutory health insurance (SHI). Input data was obtained from public databases, clinical trials and official statistics. The incremental cost-effectiveness ratio (ICER) was presented as costs per avoided hip fracture. Additionally, we performed deterministic and probabilistic sensitivity analyses and, estimated monetary consequences for the SHI in a budget impact analysis (BIA). Results For women, the costs per hip fracture avoided amounted to euro52,864 (men: euro169,805). Results of deterministic and probabilistic sensitivity analyses confirmed the robustness of the results. According to the BIA, for the reimbursement of FPE additional costs of euro3.0 million (women) and euro7.8 million (men) are expected for the SHI. Conclusions Group-based FPE appears to be no cost-effective option to prevent fall-related hip fractures in independently living elderly. To allow a more comprehensive statement on the cost effectiveness of FPE fracture types other than hip should be increasingly evaluated in clinical trials.

Automated summary

This study evaluates the cost-effectiveness of fall prevention exercise for independently living older people in Germany. The results suggest that group-based FPE is not a cost-effective option to prevent hip fractures in independently living elderly, with high costs per avoided fracture. More clinical trials on preventing other types of fractures are needed to provide a comprehensive assessment of the cost effectiveness of FPE.