Economic modelling of fall prevention interventions delivered by community emergency medical services: a decision-tree analysis.

Abstract

Background: Fall prevention interventions delivered by specially trained emergency medical services (EMS) clinicians in the homes of patients at high risk for falls have been shown to prevent recurrent falls. However, the cost of implementing this 'community EMS' approach to fall prevention is a barrier to widespread adoption. The objective of this study was to assess whether a community EMS fall prevention intervention results in overall cost savings for the healthcare system.

Methods: We performed a cost-effectiveness analysis using a decision-tree model of possible outcomes after an index fall in a simulated population of community-dwelling adults aged ≥65 over a 1-year time horizon. Transition probabilities and costs were obtained through literature review. The intervention, delivered in patients' homes by specialised EMS clinicians, consisted of environmental modifications, fall prevention education, referral to occupational and physical therapy, and coordination with the patient's primary care physician. We compared the mean healthcare expenditures per patient among those receiving and not receiving the fall prevention intervention.

Results: The intervention would result in a net cost savings of $964 per patient compared with no intervention, with an incremental cost-effectiveness ratio of -$22 174 per fall prevented (lower cost and more effective). Holding other variables constant, the programme would remain cost-saving if the effectiveness decreased to a 26% reduction in falls or the programme cost increased to $1634 per patient.

Conclusions: In this economic modelling analysis, a multifactorial fall prevention intervention delivered by community EMS was cost saving to the healthcare system. Healthcare payors should provide financial support and reimbursement for these programmes.