Cost-effectiveness of a home safety intervention to prevent falls in impaired elderly people living in the community.

PURPOSE: Among others, the German National Prevention Conference recently recommended the provision of preventive options for elderly to maintain their independent living. Because a home safety assessment and modification program (HSM) has shown to be effective in avoiding falls and risk of falling in elderly, the aim of this analysis was to evaluate the cost-effectiveness of HSM in patients aged ≥ 80 years who receive non-institutionalized long-term care. METHODS: In order to reflect quality-adjusted life years (QALYs) and costs resulting from HSM, a Markov-model with a time horizon of 20 years was performed from the perspective of the German statutory health insurance (SHI) and statutory long-term care insurance (LCI). The model assumed that HSM reduces fall-related hip fractures in accordance with the reduction of the rate of falls. Data was obtained from public databases and from various literature searches. The robustness of the results was assessed in deterministic and probabilistic sensitivity analyses. RESULTS: In women, the incremental cost-effectiveness ratio of HSM compared to no prevention was €9580 per QALY, while in men, it was €57,589. For the German SHI/LCI, in total, the provision of HSM to patients ≥ 80 years who receive non-institutionalized long-term care would result in annual costs of €7.7 million. The results were robust in several sensitivity analyses. CONCLUSIONS: Provided that the rate of falls is a valid surrogate endpoint for the rate of fall-related hip fractures, HSM could be a promising approach for investments in preventive options targeting the reduction of fall-related fractures in elderly women.

Applying GRADE Criteria to Clinical Inputs to Cost-Effectiveness Modeling Studies.

BACKGROUND: Concerns have been raised about the use of clinical data in cost-effectiveness models. The aim of this analysis was to evaluate the appropriate use of data on clinical effectiveness in cost-effectiveness modeling studies that were published between 2001 and 2015. METHODS: Assessors rated 72 modeling studies obtained from three therapeutic areas by applying criteria defined by the Grading of Recommendations Assessment, Development and Evaluation group for assessing the quality of clinical evidence: selection of clinical data (publication bias), imprecision, indirectness, inconsistency (i.e., heterogeneity), and study limitations (risk of bias). For all parameters included in the analyses, potential changes over time were assessed. RESULTS: Although three out of four modeling studies relied on randomized controlled trials, more than 60% of the modeling studies were based on clinical data with a high or unclear risk of bias, in more than 80%, a risk of publication bias was found, and in about 30%, evidence was based on indirect clinical evidence, having significantly increased over the years. Study limitations were inadequately described in more than one third of the studies. However, less than 10% of clinical studies showed inconsistency or imprecision in study results. CONCLUSION: Despite the fact that the majority of economic evaluations are based on precise and consistent randomized controlled trials, their results are often affected by limitations arising from methodological shortcomings in the underlying data on clinical efficacy. Modelers and assessors should be more aware of aspects surrounding the quality of clinical evidence as considered by the Grading of Recommendations Assessment, Development and Evaluation group.