The cost-effectiveness of the Dutch In Balance fall prevention intervention compared to exercise recommendations among community-dwelling older adults with an increased risk of falls: A randomized controlled trial

Background: Falls among older adults are a growing public health issue, and are associated with injuries and increased societal costs. Therefore, implementation of effective fall prevention interventions is important. Given limited healthcare resources, evaluating the cost-effectiveness of these interventions is essential. Therefore, we aimed to evaluate the cost-effectiveness of the In Balance fall prevention intervention for community-dwelling older adults with an increased risk of falls compared to general physical activity recommendations (control) from a societal perspective. Methods: An economic evaluation was conducted alongside a twelve month, single-blind, multicenter randomized controlled trial. Participants were 264 non- and pre-frail community-dwelling adults aged 65 years or older with an increased fall risk. We assessed costs from a societal perspective and effects included the number of falls, fall-related injuries, and Quality-Adjusted Life Years (QALYs) based on the EuroQol Five-level questionnaire (EQ-5D-5L) and the Adult Social Care Outcomes Toolkit (ASCOT). Missing data were handled using Multiple Imputation by Chained Equations (MICE). Incremental costs and effects were estimated using Seemingly Unrelated Regressions and used to estimate Incremental cost-effectiveness ratios (ICERs). Results: On average, In Balance was less expensive and more effective than control, but differences were not statistically significant. ICERs indicated dominance of the intervention for prevented falls (€-14,329 per prevented fall), prevented fall-related injuries (€-14,569 per prevented injury), and QALYs based on both the EQ-5D-5L (€-168,265 per QALY gained) and ASCOT (€-135,797 per QALY gained). The probability of cost-effectiveness of In Balance compared to control was 98% at a willingness to pay (WTP) of €0 per unit of effect gained. Conclusions: Based on this study, we conclude that In Balance may be considered cost-effective compared to control. Future research should explore whether In Balance as part of a comprehensive fall prevention strategy is cost-effective. Trial registration: Research with human participants: NL9248 (registered February 13 2021, URL: https://www.onderzoekmetmensen.nl/nl/trial/26195)