Abstract
Summary
Our objective was to determine international estimates of the economic burden of falls in older people living in the community. Our systematic review emphasized the need for a consensus on methodology for cost of falls studies to enable more accurate comparisons and subgroup-specific estimates among different countries.
Introduction
The purpose of this study was to determine international estimates of the economic burden of falls in older people living in the community.
Methods
This is a systematic review of peer-reviewed journal articles reporting estimates for the cost of falls in people aged ≥60 years living in the community. We searched for papers published between 1945 and December 2008 in MEDLINE, PUBMED, EMBASE, CINAHL, Cochrane Collaboration, and NHS EED databases that identified cost of falls in older adults. We extracted the cost of falls in the reported currency and converted them to US dollars at 2008 prices, cost items measured, perspective, time horizon, and sensitivity analysis. We assessed the quality of the studies using a selection of questions from Drummond’s checklist.
Results
Seventeen studies met our inclusion criteria. Studies varied with respect to viewpoint of the analysis, definition of falls, identification of important and relevant cost items, and time horizon. Only two studies reported a sensitivity analysis and only four studies identified the viewpoint of their economic analysis. In the USA, non-fatal and fatal falls cost US $23.3 billion (2008 prices) annually and US $1.6 billion in the UK.
Conclusions
The economic cost of falls is likely greater than policy makers appreciate. The mean cost of falls was dependent on the denominator used and ranged from US $3,476 per faller to US $10,749 per injurious fall and US $26,483 per fall requiring hospitalization. A consensus on methodology for cost of falls studies would enable more accurate comparisons and subgroup-specific estimates among different countries.
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References
Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337:1279–1284
Campbell AJ, Borrie MJ, Spears GF (1989) Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 44:M112–M117
Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707
National Center for Injury Prevention and Control (1998) National Center for Injury Prevention and Control: statistics and activities. Int J Trauma Nurs 4:18–22
Sattin RW, Lambert Huber DA, DeVito CA, Rodriguez JG, Ros A, Bacchelli S, Stevens JA, Waxweiler RJ (1990) The incidence of fall injury events among the elderly in a defined population. Am J Epidemiol 131:1028–1037
Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA (2009) Does a home-based strength and balance programme in people aged ≥80 years provide the best value for money to prevent falls? A systematic review of economic analyses of falls prevention interventions. Br J Sports Med. 6 Aug 2009 (Epub ahead of print). doi:10.1136/bjsm.2009.060988
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 354:1896–1900
Drummond MF, Sculpher MJ, Torrance GW, O'Brien B, Stoddart GL (2005) Methods for the economic evaluation of health care programmes, 3rd edn. Oxford University Press, New York
US Department of Labour. www.bls.gov/data/, accessed July 2009
Welte R, Feenstra T, Jager H, Leidl R (2004) A decision chart for assessing and improving the transferability of economic evaluation results between countries. Pharmacoeconomics 22:857–876
Englander F, Hodson TJ, Terregrossa RA (1996) Economic dimensions of slip and fall injuries. J Forensic Sci 41:733–746
Carroll NV, Slattum PW, Cox FM (2005) The cost of falls among the community-dwelling elderly. J Manag Care Pharm 11:307–316
Rizzo JA, Friedkin R, Williams CS, Nabors J, Acampora D, Tinetti ME (1998) Health care utilization and costs in a Medicare population by fall status. Med Care 36:1174–1188
Stevens JA, Corso PS, Finkelstein EA, Miller TR (2006) The costs of fatal and non-fatal falls among older adults. Inj Prev 12:290–295
Finkelstein EA, Chen H, Miller TR, Corso PS, Stevens JA (2005) A comparison of the case–control and case–crossover designs for estimating medical costs of nonfatal fall related injuries among older Americans. Med Care 43:1087–1091
Alexander BH, Rivara FP, Wolf ME (1992) The cost and frequency of hospitalization for fall related injuries in older adults. Am J Public Health 82:1020–1023
Roudsari BS, Ebel BE, Corso PS, Molinari NA, Koepsell TD (2005) The acute medical care costs of fall related injuries among the U.S. older adults. Injury 36:1316–1322
Ellis AA, Trent RB (2001) Do the risks and consequences of hospitalized fall injuries among older adults in California vary by type of fall? J Gerontol A Biol Sci Med Sci 56:M686–M692
Mahoney JE, Glysch RL, Guilfoyle SM, Hale LJ, Katcher ML (2005) Trends, risk factors, and prevention of falls in older adults in Wisconsin. WMJ 104:22–28
Newton JL, Kyle P, Liversidge P, Robinson G, Wilton K, Reeve P (2006) The costs of falls in the community to the North East Ambulance Service. Emerg Med J 23:479–481
Scuffham P, Chaplin S, Legood R (2003) Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health 57:740–744
Hall SE, Hendrie DV (2003) A prospective study of the costs of falls in older adults living in the community. Aust N Z J Public Health 27:343–351
Hendrie D, Hall SE, Arena G, Legge M (2004) Health system costs of falls of older adults in Western Australia. Aust Health Rev 28:363–373
Seematter-Bagnoud L, Wietlisbach V, Yersin B, Bula CJ (2006) Healthcare utilization of elderly persons hospitalized after a noninjurious fall in a Swiss academic medical center. J Am Geriatr Soc 54:891–897
Cotter PE, Timmons S, O’Connor M, Twomey C, O'Mahony D (2006) The financial implications of falls in older people for an acute hospital. Ir J Med Sci 175:11–13
Panneman MJ, Goettsch WG, Kramarz P, Herings RM (2003) The costs of benzodiazepine-associated hospital-treated fall injuries in the EU: a Pharmo Study. Drugs Aging 20:833–839
Sjogren H, Bjornstig U (1991) Trauma in the elderly: the impact on the health care system. Scand J Prim Health Care 9:203–207
Bansback N, Ara R, Ward S, Anis A, Choi HK (2009) Statin therapy in rheumatoid arthritis: a cost-effectiveness and value-of-information analysis. Pharmacoeconomics 27:25–37
Mycek S (2004) The dire cost of obesity. Mater Manag Health Care 13:18–21
Drummond MF, Barbieri M, Cook J, Glick HA, Lis J, Malik F, Reed S, Rutten F, Sculpher M, Severens J (2009) Transferability of economic evaluations across jurisdictions: ISPOR Good Research Practices Task Force Report. Value Health 12:409–418
Yabroff KR, Warren JL, Banthin J, Schrag D, Mariotto A, Lawrence W, Meekins A, Topor M, Brown ML (2009) Comparison of approaches for estimating prevalence costs of care for cancer patients: what is the impact of data source? Med Care 47:S64–S69
Yabroff KR, Warren JL, Schrag D, Mariotto A, Meekins A, Topor M, Brown ML (2009) Comparison of approaches for estimating incidence costs of care for colorectal cancer patients. Med Care 47:S56–S63
Koopmanschap MA (1998) Cost-of-illness studies. Useful for health policy? Pharmacoeconomics 14:143–148
Hodgson TA, Meiners MR (1982) Cost-of-illness methodology: a guide to current practices and procedures. Milbank Mem Fund Q Health Soc 60:429–462
Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews Issue 2. Art.No.:CD007146. doi:10.1002/14651858.CD007146.pub2
Acknowledgments
Jennifer C. Davis is funded by a Michael Smith Foundation for Health Research Senior Graduate Studentship, a Canadian Institute for Health Research Canada Graduate Scholarship, and the Centre for Hip Health and Mobility. Maureen C. Ashe and Teresa Liu-Ambrose are funded by a Michael Smith Foundation for Health Research Scholar Award. Carlo A. Marra is funded by a Canada Research Chair in Pharmaceutical Outcomes and a Michael Smith Foundation for Health Research Scholar Award.
Author contributions
Jennifer C. Davis, M. Clare Robertson, Maureen C. Ashe: Study concept and design, extraction of data, analysis and interpretation of data, preparation of manuscript, and critical review of manuscript. Teresa Liu-Ambrose, Carlo A. Marra, and Karim M. Khan: Study concept and design, analysis and interpretation of data, preparation of manuscript, and critical review of manuscript.
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Davis, J.C., Robertson, M.C., Ashe, M.C. et al. International comparison of cost of falls in older adults living in the community: a systematic review. Osteoporos Int 21, 1295–1306 (2010). https://doi.org/10.1007/s00198-009-1162-0
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DOI: https://doi.org/10.1007/s00198-009-1162-0