Cost-effectiveness of Integrating Falls Prevention into Primary Healthcare in Rural China: Findings from the FAMILY trial

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T Wei1; J Peng2; P Ye3; L Xu4; G Kolt1; S Jan4; Y Wang5; R Ivers6; M Tian2,5; L Si1

1. School of Health Sciences, Western Sydney University; 2. School of Public Health, Harbin Medical University; 3. National Center for NCD Control and Prevention, China CDC; 4. The George Institute for Global Health, UNSW; 5. The Second Affiliated Hospita

Scientific Research

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Abstract

Introduction

Falls and fall-related injuries are the leading cause of morbidity and mortality for older adults. China’s rapidly aging population and ever-growing demands for available resources has highlighted the need for falls-prevention programs that deliver value for money. FAMILY, a 12-month cluster randomised controlled trial conducted in 128 Chinese rural villages involving 2610 community-dwelling older adults demonstrated that a balance and functional exercise program integrated in the primary healthcare system reduced falls. This study aimed to assess the cost-effectiveness of the FAMILY intervention.

Methods

A within-trial economic evaluation of FAMILY was conducted from a healthcare system perspective. Incremental cost and effectiveness, including falls prevented and quality-adjusted life-years (QALYs), were estimated using mixed-effects regression models accounting for clustering. Healthcare resource use costs and the intervention costs were included. QALYs were estimated using EQ-5D-5L outcomes collected during the trial. One-way sensitivity analyses were conducted to evaluate the robustness of the base case results. Probabilistic sensitivity analysis (PSA) using a two-stage bootstrapping was conducted to estimate the parameter uncertainty.

Results

During a mean follow-up of 358 days, the intervention was dominant, with lower costs and greater effectiveness. It reduced the absolute risk of fall by 8.6% and generated an average additional 0.023 QALYs per person. Mean total costs were ¥289 (95% CI: -¥173 to ¥742) lower in the intervention group, primarily driven by costs of treating fall-related injuries (¥1,539 in the intervention group versus ¥1,828 in the control group), despite an intervention delivery cost of ¥20 per participant. One-way sensitivity analyses showed that the base-case results were robust. PSA showed that the intervention had a 90% probability of being cost saving and a 96% probability of being cost-effective.

Conclusions

Our study confirms that integrating a falls prevention program into primary healthcare in rural China saves healthcare costs and improves health outcomes.