title: Preventive home visits to older people are cost-effective Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls Economic evaluation of a community based exercise programme to prevent falls Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT. Breaking bones, breaking budgets: a clinical and economic evaluation of a prospective, randomized, practice controlled, intervention study in the prevention of accidents in primary care. Economic Analysis of Primary Care‐Based Physical Activity Counseling in Older Men: The VA‐LIFE Trial Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability. A preventative lifestyle intervention for older adults (lifestyle matters): a randomised controlled trial Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population Evaluating the cost-effectiveness of fall prevention programs that reduce fall-related hip fractures in older adults. Cost effectiveness of a community based exercise programme in over 65 year olds: cluster randomised trial A cost analysis of a physical activity intervention for older adults. Costs and quality of life associated with osteoporosis-related fractures in Sweden A cost-benefit analysis of three older adult fall prevention interventions. Cost-effectiveness of a multidisciplinary fall prevention program in community-dwelling elderly people: a randomized controlled trial (ISRCTN 64716113). Cost-effectiveness of a multifactorial fall prevention program in nursing homes Cost effectiveness of preventive home visits to the elderly Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 2: Controlled trial in multiple centres Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: Results of a cluster randomized trial Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care. The cost effectiveness of a home hazard reduction program to reduce falls among older persons
abstract: Aims : There is ongoing debate over the effectiveness of preventive home visits ( PHVs ) for the elderly . A municipality in the north of Sweden carried out a controlled trial of such visits . Healthy seniors aged 75 years and over received two PHVs per year over 2 years . The aim of this study was to do a cost utility analysis of the intervention . Methods : The intervention group ( n=196 ) was compared with a control group ( n=346 ) , and a  cost utility analysis was performed . The analysis was carried out with three different time perspectives . Data were source d from official documents and medical and social records . Results : From a societal perspective , using a time period of 4 years , the analysis of PHVs to healthy seniors showed net savings . When including estimated future costs for health and elderly care during gained life years , the result changed from a net saving to a cost of Euro 200,000 . A lifetime perspective also result ed in net savings if the costs of future health and elderly care were not included in the analysis . In this case , the total costs rose to approximately Euro 900,000 . The cost could also be expressed as Euro 14,200 per quality -adjusted life year gained if future costs for elderly care and healthcare were included . Conclusions : PHVs represent a cost-effective intervention in this setting . The costs are justified by the outcomes Background : multifactorial falls prevention programmes for older people have been proved to reduce falls . However , evidence of their cost-effectiveness is mixed . Design : economic evaluation alongside pragmatic r and omised controlled trial . Intervention : r and omised trial of 364 people aged ≥70 , living in the community , recruited via GP and identified as high risk of falling . Both arms received a falls prevention information leaflet . The intervention arm were also offered a ( day hospital ) multidisciplinary falls prevention programme , including physiotherapy , occupational therapy , nurse , medical review and referral to other specialists . Measurements : self-reported falls , as collected in 12 monthly diaries . Levels of health re source use associated with the falls prevention programme , screening ( both attributed to intervention arm only ) and other health-care contacts were monitored . Mean NHS costs and falls per person per year were estimated for both arms , along with the incremental cost-effectiveness ratio ( ICER ) and cost effectiveness acceptability curve . Results : in the base-case analysis , the mean falls programme cost was £ 349 per person . This , coupled with higher screening and other health-care costs , result ed in a mean incremental cost of £ 578 for the intervention arm . The mean falls rate was lower in the intervention arm ( 2.07 per person/year ) , compared with the control arm ( 2.24 ) . The estimated ICER was £ 3,320 per fall averted . Conclusions : the estimated ICER was £ 3,320 per fall averted . Future research should focus on adherence to the intervention and an assessment of impact on quality of life OBJECTIVE To assess the incremental costs and cost effectiveness of implementing a home based muscle strengthening and balance retraining programme that reduced falls and injuries in older women . DESIGN An economic evaluation carried out within a r and omised controlled trial with two years of follow up . Participants were individually prescribed an exercise programme ( exercise group , n=116 ) or received usual care and social visits ( control group , n=117 ) . SETTING 17 general practice s in Dunedin , New Zeal and . PARTICIPANTS Women aged 80 years and older living in the community and invited by their general practitioner to take part . MAIN OUTCOME MEASURES Number of falls and injuries related to falls , costs of implementing the intervention , healthcare service costs result ing from falls and total healthcare service costs during the trial . Cost effectiveness was measured as the incremental cost of implementing the exercise programme per fall event prevented . MAIN RESULTS 27 % of total hospital costs during the trial were related to falls . However , there were no significant differences in health service costs between the two groups . Implementing the exercise programme for one and two years respectively cost $ 314 and $ 265 ( 1995 New Zeal and dollars ) per fall prevented , and $ 457 and $ 426 per fall result ing in a moderate or serious injury prevented . CONCLUSIONS The costs result ing from falls make up a substantial proportion of the hospital costs for older people . Despite a reduction in falls as a result of this home exercise programme there was no significant reduction in healthcare costs . However , the results reported will provide information on the cost effectiveness of the programme for those making decisions on falls prevention strategies BACKGROUND Mild frailty or pre-frailty is common and yet is potentially reversible . Preventing progression to worsening frailty may benefit individuals and lower health/social care costs . However , we know little about effective approaches to preventing frailty progression . OBJECTIVES ( 1 ) To develop an evidence - and theory-based home-based health promotion intervention for older people with mild frailty . ( 2 ) To assess feasibility , costs and acceptability of ( i ) the intervention and ( ii ) a full-scale clinical effectiveness and cost-effectiveness r and omised controlled trial ( RCT ) . DESIGN Evidence review s , qualitative studies , intervention development and a feasibility RCT with process evaluation . INTERVENTION DEVELOPMENT Two systematic review s ( including systematic search es of 14 data bases and registries , 1990 - 2016 and 1980 - 2014 ) , a state-of-the-art review ( from inception to 2015 ) and policy review identified effective components for our intervention . We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people ( aged 65 - 94 years ) ( n = 44 ) , carers ( n = 12 ) and health/social care professionals ( n = 27 ) . These data , and our evidence review s , fed into development of the ' HomeHealth ' intervention in collaboration with older people and multidisciplinary stakeholders . ' HomeHealth ' comprised 3 - 6 sessions with a support worker trained in behaviour change techniques , communication skills , exercise , nutrition and mood . Participants addressed self-directed independence and well-being goals , supported through education , skills training , enabling individuals to overcome barriers , providing feedback , maximising motivation and promoting habit formation . FEASIBILITY RCT Single-blind RCT , individually r and omised to ' HomeHealth ' or treatment as usual ( TAU ) . SETTING Community setting s in London and Hertfordshire , UK . PARTICIPANTS A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty . MAIN OUTCOME MEASURES Feasibility - recruitment , retention , acceptability and intervention costs . Clinical and health economic outcome data at 6 months included functioning , frailty status , well-being , psychological distress , quality of life , capability and NHS and societal service utilisation/costs . RESULTS We successfully recruited to target , with good 6-month retention ( 94 % ) . Trial procedures were acceptable with minimal missing data . Individual r and omisation was feasible . The intervention was acceptable , with good fidelity and modest delivery costs ( £ 307 per patient ) . A total of 96 % of participants identified at least one goal , which were mostly exercise related ( 73 % ) . We found significantly better functioning ( Barthel Index + 1.68 ; p = 0.004 ) , better grip strength ( + 6.48 kg ; p = 0.02 ) , reduced psychological distress ( 12-item General Health Question naire -3.92 ; p = 0.01 ) and increased capability-adjusted life-years [ + 0.017 ; 95 % confidence interval ( CI ) 0.001 to 0.031 ] at 6 months in the intervention arm than the TAU arm , with no differences in other outcomes . NHS and carer support costs were variable but , overall , were lower in the intervention arm than the TAU arm . The main limitation was difficulty maintaining outcome assessor blinding . CONCLUSIONS Evidence is lacking to inform frailty prevention service design , with no large-scale trials of multidomain interventions . From stakeholder/public perspectives , new frailty prevention services should be personalised and encompass multiple domains , particularly socialising and mobility , and can be delivered by trained non-specialists . Our multicomponent health promotion intervention was acceptable and delivered at modest cost . Our small study shows promise for improving clinical outcomes , including functioning and independence . A full-scale individually RCT is feasible . FUTURE WORK A large , definitive RCT of the HomeHealth service is warranted . STUDY REGISTRATION This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials IS RCT N11986672 . FUNDING This project was funded by the National Institute for Health Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 21 , No. 73 . See the NIHR Journals Library website for further project information OBJECTIVE This longitudinal study was design ed to assess the effect of an educational training package for primary health care teams in accident prevention for older people , with reference to the incidence of accidents and their associated economic consequence . METHODS Nineteen general practice s in the West Midl and s serving a population of 138 397 were allocated r and omly at the practice level either to receive  training  or continue normal practice . Study data was collated from the initial telephone call , reporting an accident , to the surgery , advice/treatment given at the practice and /or the community , casualty , inpatient care , written correspondence to the patient 's GP and any subsequent follow-up visits for accidents to people aged 65 years or older . RESULTS One thous and , six hundred and sixty-six ( 8.2 % ) patients aged 65 years or older registered with the participating practice s experienced one accident or more , costing the NHS pound 1.4 million . Extrapolated nationally , annual costs to the NHS for accidents to older people amount to pound 568 million . The educational package had no significant impact on the incidence of accidents . A paucity of general safety advice was given [ 48 ( 1.8 % ) occasions ] . CONCLUSIONS Budgets are being eroded and patients are suffering unnecessarily due to lack of accident prevention advice . This should be considered a priority within the primary health care team . Educational packages alone do not appear to be a cost-effective approach to accident prevention in primary care OBJECTIVES To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans . DESIGN Secondary objective of r and omized trial that assessed the effect of exercise counseling ( relative to usual care ) on physical performance , physical activity , function , disability , and medical re source use and cost . SETTING Veterans Affairs Medical Center , Durham , North Carolina . PARTICIPANTS Male veterans aged ≥70 years ( n = 398 ) . INTERVENTION An experienced health counselor provided baseline in-person exercise counseling , followed by telephone counseling at 2 , 4 , and 6 weeks , and monthly thereafter through one year . Each participant 's primary care physician provided initial endorsement of the intervention , followed by monthly automated telephone messages tailored to the patient . Individualized progress reports were mailed quarterly . MEASUREMENTS Intervention costs were assessed . Health care re source use and costs were estimated from enrollment through one year follow-up . The incremental cost of achieving clinical ly significant changes in major trial endpoints was calculated . RESULTS The total direct cost of the intervention per participant was $ 459 , 85 % of which was counselor effort . With overhead , program cost totaled $ 696 per participant . Medical costs during follow-up reached $ 10,418 with the intervention , versus $ 12,052 with usual care ( difference = -$1,634 ( 95 % confidence interval = -$4,683 to $ 1,416 ; P = .29 ) ) . Expressed in terms of short-term clinical outcomes , the intervention cost $ 4,971 per additional patient reaching target exercise levels , or $ 4,640 per patient achieving a clinical ly significant change in rapid gait speed . CONCLUSION Improvements in physical activity and rapid gait speed  in the physical activity counseling group were obtained at a cost that represents a small fraction of patients ' annual health care costs BACKGROUND Losing the ability to walk safely and independently is a major concern for many older adults . The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity ( PA ) intervention can delay the onset of major mobility disability . Our objective is to examine the re sources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention . METHODS The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability . They were recruited at eight field centers and r and omly assigned to either PA or health education . The PA program consisted of 50-minute center-based exercise 2 × weekly , augmented with home-based activity to achieve a goal of 150 min/wk of PA . Health education consisted of weekly workshops for 26 weeks , and monthly sessions thereafter . Analyses were conducted from a health system perspective , with a 2.6-year time horizon . RESULTS The average cost per participant over 2.6 years was US$ 3,302 and US$ 1,001 for the PA and health education interventions , respectively . PA participants accrued 0.047 per person more Quality -Adjusted Life-Years ( QALYs ) than health education participants . PA interventions costs were slightly higher than other recent PA interventions . The incremental cost-effectiveness ratios were US$ 42,376/major mobility disability prevented and US$ 49,167/QALY . Sensitivity analyses indicated that results were relatively robust to varied assumptions . CONCLUSIONS  The PA intervention costs and QALYs gained are comparable to those found in other studies . The ICERS are less than many commonly recommended medical treatments . Implementing the intervention in non- research setting s may reduce costs further Abstract Objectives to test whether an occupation-based lifestyle intervention can sustain and improve the mental well-being of adults aged 65 years or over compared to usual care , using an individually r and omised controlled trial . Participants 288 independently living adults aged 65 years or over , with normal cognition , were recruited from two UK sites between December 2011 and November 2015 . Interventions lifestyle Matters is a National Institute for Health and Care Excellence recommended multi-component preventive intervention design ed to improve the mental well-being of community living older people at risk of decline . It involves weekly group sessions over 4 months and one to one sessions . Main outcome measures the primary outcome was mental well-being at 6 months ( mental health ( MH ) dimension of the SF-36 ) . Secondary outcomes included physical health dimensions of the SF-36 , extent of depression ( PHQ-9 ) , quality of life ( EQ-5D ) and loneliness ( de Jong Gierveld Loneliness Scale ) , assessed at 6 and 24 months . Results data on 262 ( intervention = 136 ; usual care = 126 ) participants were analysed using intention to treat analysis . Mean SF-36 MH scores at 6 months differed by 2.3 points ( 95 CI : −1.3 to 5.9 ; P = 0.209 ) after adjustments . Conclusions analysis shows little evidence of clinical or cost-effectiveness in the recruited population with analysis of the primary outcome revealing that the study participants were mentally well at baseline . The results pose questions regarding how preventive interventions to promote well-being in older adults can be effectively targeted in the absence of proactive mechanisms to identify those who at risk of decline . Trial Registration IS RCT N67209155 Background Falls among older people are of growing concern globally . Implementing cost-effective strategies for their prevention is of utmost importance given the ageing population and associated potential for increased costs of fall-related injury over the next decades . The purpose of this study was to undertake a cost-utility analysis and secondary cost-effectiveness analysis from a healthcare system perspective , of a group-based exercise program compared to routine care for falls prevention in an older community-dwelling population . Methods A decision analysis using a decision tree model was based on the results of a previously published r and omised controlled trial with a community-dwelling population aged over 70 .  Measures of falls , fall-related injuries and re source use were directly obtained from trial data and supplemented by literature -based utility measures . A sub-group analysis was performed of women only . Cost estimates are reported in 2010 British Pound Sterling ( GBP ) . Results The ICER of GBP£51,483 per QALY for the base case analysis was well above the accepted cost-effectiveness threshold of GBP£20,000 to £ 30,000 per QALY , but in a sensitivity analysis with minimised program implementation the incremental cost reached GBP£25,678 per QALY . The ICER value at 95 % confidence in the base case analysis was GBP£99,664 per QALY and GBP£50,549 per QALY in the lower cost analysis . Males had a 44 % lower injury rate if they fell , compared to females result ing in a more favourable ICER for the women only analysis . For women only the ICER was GBP£22,986 per QALY in the base case and was below the cost-effectiveness threshold for all other variations of program implementation . The ICER value at 95 % confidence was GBP£48,212 in the women only base case analysis and GBP£23,645 in the lower cost analysis . The base case incremental cost per fall averted was GBP£652 ( GBP£616 for women only ) . A threshold analysis indicates that this exercise program can not realistically break even . Conclusions The results suggest that this exercise program is cost-effective for women only . There is no evidence to support its cost-effectiveness in a group of mixed gender unless the costs of program implementation are minimal . Conservative assumptions may have underestimated the true cost-effectiveness of the program OBJECTIVES To model the incremental cost-utility of seven interventions reported as effective for preventing falls in older adults . DESIGN Mathematical epidemiological model populated by data based on direct clinical experience and a critical review of the literature . SETTING Model represents population level interventions . PARTICIPANTS No human subjects were involved in the study . MEASUREMENS : The last Cochrane data base review and meta-analyses of r and omized controlled trials categorized effective fall-prevention interventions into seven groups : medical management ( withdrawal ) of psychotropics , group tai chi , vitamin D supplementation , muscle and balance exercises , home modifications , multifactorial individualized programs for all elderly people , and multifactorial individualized treatments for high-risk frail elderly people . Fall-related hip fracture incidence was obtained from the literature . Salary figures for health professionals were based on Bureau of Labor Statistics data . Using an integrated healthcare system perspective , healthcare costs were estimated based on practice and studies on falls in older adults . Base case incremental cost utility ratios were calculated , and probabilistic sensitivity analyses were conducted . RESULTS Medical management of psychotropics and group tai chi were the least-costly , most-effective options , but they were also the least studied . Excluding these interventions , the least-expensive , most-effective options are  vitamin D supplementation and home modifications . Vitamin D supplementation costs less than home modifications , but home modifications cost only $ 14,794/ quality -adjusted life year ( QALY ) gained more than vitamin D. In probabilistic sensitivity analyses excluding management of psychotropics and tai chi , home modification is most likely to have the highest economic benefit when QALYs are valued at $ 50,000 or $ 100,000 . CONCLUSION Of single interventions studied , management of psychotropics and tai chi reduces costs the most . Of more-studied interventions , home modifications provide the best value . These results must be interpreted in the context of the multifactorial nature of falls Objective : To assess the cost effectiveness of a community based exercise programme as a population wide public health intervention for older adults . Design : Pragmatic , cluster r and omised community intervention trial . Setting : 12 general practice s in Sheffield ; four r and omly selected as intervention population s , and eight as control population s. Participants : All those aged 65 and over in the least active four fifths of the population responding to a baseline survey . There were 2283 eligible participants from intervention practice s and 4137 from control practice s. Intervention : Eligible subjects were invited to free locally held exercise classes , made available for two years . Main outcome measures : All cause and exercise related cause specific mortality and hospital service use at two years , and health status assessed at baseline , one , and two years using the SF-36 . A cost utility analysis was also undertaken . Results : Twenty six per cent of the eligible intervention practice population attended one or more  exercise sessions  . There were no significant differences in mortality rates , survival times , or admissions . After adjusting for baseline characteristics , patients in intervention practice s had a lower decline in health status , although this reached significance only for the energy dimension and two composite scores ( p<0.05 ) . The incremental average QALY gain of 0.011 per person in the intervention population result ed in an incremental cost per QALY ratio of € 17 174 ( 95 % CI = € 8300 to € 87 120 ) . Conclusions : Despite a low level of adherence to the exercise programme , there were significant gains in health related quality of life . The programme was more cost effective than many existing medical interventions , and would be practical for primary care commissioning agencies to implement We examined the costs of a  physical activity ( PA ) and an educational comparison intervention .  424 older adults at risk for mobility disability were r and omly assigned to either condition . The PA program consisted of center-based exercise sessions 3x weekly for 8 weeks , 2x weekly for weeks 9 to 24 and weekly behavioral counseling for 10 weeks . Optional sessions were offered during maintenance weeks ( 25 - 52 ) . The comparison intervention consisted of weekly education meetings for 24 weeks , and then monthly for 6 months . Cost analyses were conducted from the " payer 's " perspective , with a 1-year time horizon . Intervention costs were estimated by tracking personnel activities and material s used for each intervention and multiplying by national unit cost averages . The average cost/participant was $ 1134 and $ 175 for the PA and the comparison interventions , respectively . A preliminary cost/effectiveness analysis gauged the cost/disability avoided to be $ 28,206 . Costs for this PA program for older adults are comparable to those of other PA interventions . The results are preliminary and a longer study is required to fully assess the costs and health benefits of these interventions This prospect i ve observational data collection study assessed the cost and quality of life related to hip , vertebral and wrist fracture 1 year after the fracture , based on a patient sample consisting of 635 male and female patients surviving a year after fracture . Data regarding re source use and quality of life related to fractures was collected by question naires at baseline , 4 months and 12 months . Information was collected by the use of patients ’ records , register sources and by asking the patient . Quality of life was estimated with the EQ-5D question naire . Costs were estimated from a societal perspective , including direct and indirect costs . The mean fracture-related cost the year after a hip , vertebral and wrist fracture were estimated , in euros ( € ) , at € 14,221 , € 12,544 and € 2,147 , respectively [ converted from Swedish krona ( SEK ) at an exchange rate of 9.1268 SEK/€ ] . The mean reduction in quality of life was estimated at 0.17 , 0.26 and 0.06 for hip , vertebral and wrist fracture , respectively . Based on the results , the yearly burden of osteoporosis in Sweden could be estimated at € 0.5 billion ( SEK 4.6 billion ) . The patient sample for vertebral fracture was fairly small and included a high proportion of fractures leading to hospitalization , but they indicate a higher cost and loss of quality of life related to vertebral fracture than previously perceived INTRODUCTION One out of three persons aged 65 and older falls annually and 20 % to 30 % of falls result in injury . The purpose of this cost-benefit analysis was to identify community-based fall interventions that were feasible , effective , and provided a positive return on investment ( ROI ) . METHODS A third-party payer perspective was used to determine the costs and benefits of three effective fall interventions . Intervention effectiveness was based on r and omized controlled trial results . National data were used to estimate the average annual benefits from averting the direct medical costs of a fall . The net benefit and ROI were estimated for each of the interventions . RESULTS For the  Otago Exercise Program delivered to persons aged 65 and older , the net benefit was $ 121.85 per participant and the ROI was 36 % for each dollar invested . For Otago delivered to persons aged 80 and older , the net benefit was $ 429.18 and the ROI was 127 % . Tai chi : Moving for Better Balance had a net benefit of $ 529.86 and an ROI of 509 % and Stepping On had a net benefit of $ 134.37 and an ROI of 64 % . CONCLUSIONS All three fall interventions provided positive net benefits . The ROIs showed that the benefits not only covered the implementation costs but also exceeded the expected direct program delivery costs . These results can help health care funders and other community organizations select appropriate and effective fall interventions that also can provide positive returns on investment OBJECTIVES Multidisciplinary and multifactorial interventions seem to be effective in preventing falls . We aim ed to assess the cost-effectiveness of a multidisciplinary fall prevention program compared with usual Dutch healthcare in community-dwelling people 65 years of age or older who experienced a fall . METHODS Cost-effectiveness and cost-utility analysis were performed from a societal perspective . Falls and healthcare utilization were continuously measured for 12 months . Daily functioning and quality of life were measured at baseline , after 4 and 12 months . Bootstrap analyses were performed to estimate uncertainty of the findings and sensitivity analysis to assess the generalizability of assumptions made . RESULTS One hundred sixty-six participants were r and omly allocated to the experimental group and 167 to the control group .  The overall response rate was 74 percent . Healthcare and patient and family costs of both groups were comparable . Our analyses showed no effect of the intervention program on falls , daily functioning , or quality of life measures . CONCLUSIONS The multidisciplinary intervention program to prevent falls was not cost-effective compared with usual care in the Netherl and s. Notwithst and ing our findings , however , falls still have an important impact on society and individuals in terms of costs and effects . Economic evaluations study ing promising interventions to prevent falls , therefore , remain necessary Summary The purpose of this study was to analyze the cost-effectiveness of a multifactorial fall prevention program in nursing home residents . Given a willingness-to-pay ( WTP ) of 50,000 EUR per year free of femoral fracture , the probability that the intervention is cost-effective is 83 % . Introduction Despite their increased risk of falls and fractures , nursing home residents have been neglected in economic evaluations of fall prevention programs so far . The purpose of this study was to analyze , for the first time , the cost-effectiveness of a multifactorial fall prevention program in nursing home residents . Methods This study is part of a prospect i ve , unblinded , cluster , nonr and omized , controlled study focusing on the transfer of an efficacious fall prevention program into a real-world setting . The analyzed sub sample was derived from cl aims data and consisted of data on intervention ( n = 256 , residents n = 10,178 ) and control homes ( n = 893 , residents n = 22,974 ) , representing all insurants of a sickness fund ( AOK Bavaria , Germany ) who were 65 years or older , residing in a nursing home on the 31st of March 2007 and had a level of care of ≥1 according to the classification of the statutory long-term care insurance . Time free of femoral fracture ( ICD-10 , S72 ) was used as measure of health effects . Femoral fracture-related costs and intervention costs were measured from a payer perspective . Multivariate regression models were applied . Sensitivity analyses were performed and cost-effectiveness acceptability curves computed . Results Within the first year of the intervention , femoral fracture rate was significantly reduced , result ing in a nonsignificant incremental mean time of 1.41 days free of femoral fracture . Incremental mean total direct costs were 29 EUR per resident , which was not significant . The incremental cost-effectiveness ratio ( ICER ) was 7,481 EUR per year free of femoral fracture . The probability of an ICER < 50,000 EUR per year free of femoral fracture was 83 % . Conclusion Depending on the amount the decision-maker is willing to pay for the incremental effect , the fall prevention program might be cost-effective within the first year . Future studies should exp and the range of costs and effects measured We evaluated the cost effectiveness of preventive home visits  to elderly persons in Denmark alongside a 3-year r and omized controlled study . The main outcome measure was incremental costs per active life-year gained . The number of active life-years was defined as those during which the person is able independently to transfer , walk indoors , go outdoors , walk outdoors in both pleasant and poor weather , and climb stairs . In 17 of 34 municipalities health visitors and general practitioners were offered geriatric training , which focused on early signs of disability , physical activity , and interdisciplinary follow-up . The remaining 17 municipalities offered preventive home visits as usual . Outcomes were measured in 4,034 persons aged 75 or 80 years old and dwelling at home .  The difference in mean total costs between the intervention and the control group discounted at 3 % was € −856 ( 95 % CI −2,455 to 744 ) in 75-year-olds and € 694 ( −2,684 to 4,071 ) in 80-year-olds . The discounted difference in mean active life-years was 0.034 ( −0.058 to 0.125 ) and 0.197 ( 0.013 to 0.380 ) , respectively . The study did not provide conclusive evidence on the cost effectiveness of the programs under consideration Abstract Objectives : To assess the effectiveness of a trained district nurse individually prescribing a home based exercise programme to reduce  falls and injuries in elderly people and to estimate the cost effectiveness of the programme . Design : R and omised controlled trial with one year 's follow up . Setting : Community health service at a New Zeal and hospital . Participants : 240 women and men aged 75 years and older . Intervention : 121 participants received the exercise programme ( exercise group ) and 119 received usual care ( control group )  ; 90 % ( 211 of 233 ) completed the trial . Main outcome measures : Number of falls , number of injuries result ing from falls , costs of implementing the programme , and hospital costs as a result of falls . Results : Falls were reduced by 46 % ( incidence rate ratio 0.54 , 95 % confidence interval 0.32 to 0.90 ) . Five hospital admissions were due to injuries caused by falls in the control group and none in the exercise group . The programme cost $ NZ1803 ( £ 523 ) ( at 1998 prices ) per fall prevented for delivering the programme and $ NZ155 per fall prevented when hospital costs averted were considered . Conclusion : A home exercise programme , previously shown to be successful when delivered by a physiotherapist , was also effective in reducing falls when delivered by a trained nurse from within a home health service . Serious injuries and hospital admissions due to falls were also reduced . The programme was cost effective in participants aged 80 years and older compared with younger participants Abstract Objectives : To assess the effectiveness of trained nurses based in general practice s individually prescribing a home exercise programme to reduce  falls and injuries in elderly people and to estimate the cost effectiveness of the programme . Design : Controlled trial with one year 's follow up . Setting : 32 general practice s in seven southern New Zeal and centres . Participants : 450 women and men aged 80 years and older . Intervention : 330 participants received the  exercise programme ( exercise centres ) and 120 received usual care ( control centres ) ; 87 % ( 371 of 426 ) completed the trial . Main outcome measures : Number of falls , number of injuries result ing from falls , costs of implementing the programme , and hospital costs as a result of falls . Results : Falls were reduced by 30 % in the exercise centres ( incidence rate ratio 0.70 , 95 % confidence interval 0.59 to 0.84 ) . The programme was equally effective in men and women . The programme cost $ NZ418 ( £ 121 ) ( at 1998 prices ) per person to deliver for one year or $ NZ1519 ( £ 441 ) per fall prevented . Fewer participants had falls result ing in injuries , but there was no difference in the number who had serious injuries and no difference in hospital costs result ing from falls in exercise centres compared with control centres . Conclusions : An individually tailored exercise programme , delivered by trained nurses from within general practice s , was effective in reducing falls in three different centres . This strategy should be combined with other successful interventions to form part of home programmes to prevent falls in elderly people Objective To evaluate the cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people in comparison with usual care . Methods We conducted cost-effectiveness and cost-utility analyses alongside a cluster r and omized trial with one-year follow-up . Participants were aged ≥ 70 years and at increased risk of functional decline . Participants in the intervention group ( n = 1209 ) received a comprehensive geriatric assessment and individually tailored multifactorial interventions coordinated by a community-care registered nurse with multiple follow-up visits . The control group ( n = 1074 ) received usual care . Costs were assessed from a healthcare perspective . Outcome measures included disability ( modified Katz-Activities of Daily Living ( ADL ) index score ) , and quality -adjusted life-years ( QALYs ) . Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios ( ICERs ) was estimated using bootstrapped bivariate regression models while adjusting for confounders . Results There were no statistically significant differences in Katz-ADL index score and QALYs between the two groups . Total mean costs were significantly higher in the intervention group ( EUR 6518 ( SE 472 ) compared with usual care ( EUR 5214 ( SE 338 ) ; adjusted mean difference € 1457 ( 95 % CI : 572 ; 2537 ) . Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.14 at a willingness to pay ( WTP ) of EUR 50,000 per one point improvement on the Katz-ADL index score and 0.04 at a WTP of EUR 50,000 per QALY gained . Conclusion The current intervention was not cost-effective compared to usual care to prevent or postpone new disabilities over a one-year period . Based on these findings , implementation of the evaluated multifactorial nurse-led care model is not to be recommended BACKGROUND Regular physical activity ( PA ) reduces the risk of falls and hip fractures , and mortality from all causes . However , PA levels are low in the older population and previous intervention studies have demonstrated only modest , short-term improvements . OBJECTIVE To evaluate the impact of two exercise promotion programmes on PA in people aged ≥ 65 years . DESIGN The ProAct65 + study was a pragmatic , three-arm parallel design , cluster r and omised controlled trial of class-based exercise [ Falls Management Exercise ( FaME ) programme ] , home-based exercise [ Otago Exercise Programme ( OEP ) ] and usual care among older people ( aged ≥ 65 years ) in primary care . SETTING Forty-three UK-based general practice s in London and Nottingham/Derby . PARTICIPANTS A total of 1256 people ≥ 65 years were recruited through their general practice s to take part in the trial . INTERVENTIONS The FaME programme and OEP . FaME included weekly classes plus home exercises for 24 weeks and encouraged walking . OEP included home exercises supported by peer mentors ( PMs ) for 24 weeks , and encouraged walking . MAIN OUTCOME MEASURES The primary outcome was the proportion that reported reaching the recommended PA target of 150 minutes of moderate to vigorous physical activity ( MVPA ) per week , 12 months after cessation of the intervention . Secondary outcomes included functional assessment s of balance and falls risk , the incidence of falls , fear of falling , quality of life , social networks and self-efficacy . An economic evaluation including participant and NHS costs was embedded in the clinical trial . RESULTS In total , 20,507 patients from 43 general practice s were invited to participate . Expressions of interest were received from 2752 ( 13 % ) and 1256 ( 6 % ) consented to join the trial ; 387 were allocated to the FaME arm , 411 to the OEP arm and 458 to usual care . Primary outcome data were available at 12 months after the end of the intervention period for 830 ( 66 % ) of the study participants . The proportions reporting at least 150 minutes of MVPA per week rose between baseline and 12 months after the intervention from 40 % to 49 % in the FaME arm , from 41 % to 43 % in the OEP arm and from 37.5 % to 38.0 % in the usual-care arm . A significantly higher proportion in the FaME arm than in the usual-care arm reported at least 150 minutes of MVPA per week at 12 months after the intervention [ adjusted odds ratio ( AOR ) 1.78 , 95 % confidence interval ( CI ) 1.11 to 2.87 ; p = 0.02 ] . There was no significant difference in MVPA between OEP and usual care ( AOR 1.17 , 95 % CI 0.72 to 1.92 ; p = 0.52 ) . Participants in the FaME arm added around 15 minutes of MVPA per day to their baseline physical activity level . In the 12 months after the close of the intervention phase , there was a statistically significant reduction in falls rate in the FaME arm compared with the usual-care arm ( incidence rate ratio 0.74 , 95 % CI 0.55 to 0.99 ; p = 0.042 ) . Scores on the Physical Activity Scale for the Elderly showed a small but statistically significant benefit for FaME compared with usual care , as did perceptions of benefits from exercise . Balance confidence was significantly improved at 12 months post intervention in both arms compared with the usual-care arm . There were no statistically significant differences between intervention arms and the usual-care arm in other secondary outcomes , including quality -adjusted life-years  . FaME is more expensive than OEP delivered with PMs ( £ 269 vs. £ 88 per participant in London ; £ 218 vs. £ 117 in Nottingham ) . The cost per extra person exercising at , or above , target was £ 1919.64 in London and £ 1560.21 in Nottingham ( mean £ 1739.93 ) . CONCLUSION The FaME intervention increased self-reported PA levels  among community-dwelling older adults 12 months after the intervention , and significantly reduced falls . Both the FaME and OEP interventions appeared to be safe , with no significant differences in adverse reactions between study arms . TRIAL REGISTRATION This trial is registered as IS RCT N43453770 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 18 , No. 49 . See the NIHR Journals Library website for further project information BACKGROUND : The effectiveness of individual components ( other than exercise ) of multifactorial intervention packages aim ed to reduce the incidence of falls in older people is uncertain . There have been no r and omised trials of home modifications alone for the prevention of falls
target: Disregarding these method ological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and , hence , an age-based rationing of public health care
background: Background In the light of demographic developments health promotion interventions for older people are gaining importance .
  In addition to method ological challenges arising from the economic evaluation of health promotion interventions in general , there are specific method ological problems for the particular target group of older people .
  There are especially four main method ological challenges that are discussed in the literature .
  They concern measurement and valuation of informal caregiving , accounting for productivity costs , effects of unrelated cost in added life years and the inclusion of ‘ beyond-health ’ benefits .
  This paper focuses on the question whether and to what extent specific method ological requirements are actually met in applied health economic evaluations .