A break‐even analysis of a community rehabilitation falls prevention service

Abstract

Objective: To identify and compare the minimum number of clients that a multidisciplinary falls prevention service delivered through domiciliary or centrebased care needs to treat to allow the service to reach a 'break-even' point. Results: It is estimated that a multidisciplinary community falls prevention team would need to see 57 clients per year to make the service break-even using a centre-based model of care and 78 clients for a domiciliary-based model. Conclusions and Implications:The service this study was based on has the capability to see around 300 clients

Economic Models of Community-Based Falls Prevention: A Systematic Review With Subsequent Commissioning And Methodological Recommendations

“…Two models targeted general adult populations aged 65+ which would contain a minority of institutionalised adults [49,50]; two incorporated institutionalisation as a non-nal model state [51,52]. Five targeted populations with falls history [53][54][55][56][57] There were four types of economic analysis: cost-effectiveness analysis (CEA), cost-bene t analysis, (CBA), return-on-investment analysis (ROI), and CUA. There were two costing perspectives: public sector and societal.…”

“…The second lowest scored item was item 21, which recommends: (i) reporting intervention costs and all-cause/fall-related healthcare costs separately; and (ii) reporting both aggregate and mean costs. For this, eight followed both recommendations [47,53,54,57,62,71,74, 83], ve followed (i) only [55,78,85,88, 89], and four followed (ii) only [48,81,86,91]. The third lowest scored item was item 8 for clearly stating and justifying the comparator which, as discussed above, was done by less than half (n=22) of studies.…”

“…Exercise was the most evaluated intervention type with 17 models; eight evaluated multiple exercise forms. Multifactorial intervention was the second most evaluated type with 13 models: three evaluated multiple forms [53,68,69]; two combined multifactorial intervention with environmental modi cations [70,71]. 1 This applies the adapted reporting/methodological quality checklist designed speci cally for falls prevention economic evaluations [31].…”

Qualitative research to inform economic modelling: a case study in older people’s views on implementing the NICE falls prevention guideline

“…One economic model, for example, incorporated the cost of a citywide falls risk screening that was assumed to operate like a cancer screening programme [ 65 ]. Costs that are fixed/sunk would interact with uptake rate to produce worse cost-effectiveness if uptake is inadequate [ 66 ] and economies of scale if uptake is increased [ 65 ]. Hence, models should accurately portray the cost structure (fixed vs. variable) to characterise the impact of implementation quality on cost-effectiveness.…”

Randomized Trial of Domiciliary Versus Center-based Rehabilitation: Which is More Effective in Reducing Falls and Improving Quality of Life in Older Fallers?

“…A recent break-even analysis of community rehabilitation falls prevention services found that whilst both home based and centre based services were able to break-even and thus be worth implementing from a societal perspective. The centre-based service however offered better value for money due to lower variable costs associated with providing the service 9 . Another study comparing home to day hospital rehabilitation following hospital discharge, found that while both groups recorded significant improvements in all functional measures from baseline at three months, the day hospital group was twice as likely to be re-admitted 10 .…”