Cost effectiveness of patient education for the prevention of falls in hospital: economic evaluation from a randomized controlled trial
1 Allied Health Research Unit, Southern Health, Corner of Warrigal and Kingston Roads, Cheltenham, Victoria 3192, Australia
2 Physiotherapy Department, School of Primary Health Care, Monash University, McMahons Road, Frankston, Victoria 3199, Australia
3 School of Physiotherapy, The University of Notre Dame Australia, Mouat Street, Fremantle, Western Australia 6160, Australia
4 School of Physiotherapy, Curtin University, Kent St, Bentley, Western Australia 6102, Australia
5 School of Health and Rehabilitation Sciences, The University of Queensland, Services Road, St Lucia, Queensland 4072, Australia
6 Centre for Research in Evidence-Based Practice, Bond University, University Drive, Robina, Queensland 4226, Australia
7 WA Centre for Health & Ageing, Centre for Medical Research and School of Medicine & Pharmacology, University of Western Australia, Stirling Highway, Crawley, Western Australia 6009, Australia
8 Centre for Functioning and Health Research, Metro South Health, Cnr of Ipswich Road and Cornwall Street, Buranda, Brisbane, Queensland 4102, Australia
9 Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Queensland 4059, Australia
BMC Medicine 2013, 11:135 doi:10.1186/1741-7015-11-135Published: 22 May 2013
Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital inpatients. Falls can threaten both immediate and longer-term health and independence. There is need to identify cost-effective means for preventing falls in hospitals. Hospital-based falls prevention interventions tested in randomized trials have not yet been subjected to economic evaluation.
Incremental cost-effectiveness analysis was undertaken from the health service provider perspective, over the period of hospitalization (time horizon) using the Australian Dollar (A$) at 2008 values. Analyses were based on data from a randomized trial among n = 1,206 acute and rehabilitation inpatients. Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research. The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients.
The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$14,591 (2008). The education program cost A$526 (2008) to prevent one cognitively intact patient becoming a faller and A$294 (2008) to prevent one fall based on primary trial data. These estimates were unstable due to high variability in the hospital costs accrued by individual patients involved in the trial. There was a 52% probability the complete program was both more effective and less costly (from the health service perspective) than providing usual care alone. Decision tree modeling sensitivity analyses identified that when provided in real life contexts, the program would be both more effective in preventing falls among cognitively intact inpatients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0%.
This economic evaluation was designed to assist health care providers decide in what circumstances this intervention should be provided. If the proportion of cognitively intact patients falling on a ward under usual care conditions is 4% or greater, then provision of the complete program in addition to usual care will likely both prevent falls and reduce costs for a health service.
Australia and New Zealand Clinical Trials Register: ACTRN12608000015347.