The Cost-effectiveness Of The Stopping Elderly Accidents, Deaths And Injuries Options Randomised Quality Improvement Trial To Prevent Falls Among Older Adults

Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Options was a randomized trial of a telemedicine implementation of the CDC’s STEADI older adult fall prevention initiative implemented among adults ages 65 and older at increased risk for falls.Using STEADI Options and published data, we simulated the intervention’s cost-effectiveness as compared to standard of care from the healthcare payer’s perspective, over a one-year time horizon with a 0% discount rate. Using an incremental net benefit (INB) framework we estimated cost-effectiveness assuming a baseline willingness-to-pay (WTP) of $25 478 to prevent one medically treated fall and performed univariate and probabilistic sensitivity analyses.Cumulatively when compared to the control participants, those in the intervention cost -$873 (95% U.I. -$3839, $2081) less, experienced fewer falls treated within the healthcare system −0.037 (95% Confidence interval (C.I.), −0.090, 0.015), and fewer falls treated by other providers −0.007 (95% C.I. -0.070, 0.053). The intervention’s INB of $1995 (95% U.I. -$2166, $6118) per enrollee, was cost saving in 71.8% of simulations and cost-effective in 82.9% of simulations. Cost-effectiveness was insensitive to wide changes in the model’s parameters, was cost-effective in 71.8% of simulations at a WTP of $0 and 85.4% of simulations at a WTP of $50 000.Within the study cohort, the intervention was highly likely to be cost-effective. However, differences in medically treated falls and total healthcare costs were not statistically significant; therefore, we cannot rule out the possibility that the intervention had no impact.