118 | Chapter 6 Adverse events No severe adverse events happened that were related to the intervention during this study. DISCUSSION The aim of this study was to evaluate the cost-effectiveness of the In Balance fall prevention intervention in comparison with written general physical activity recommendations among community-dwelling non-frail and pre-frail older adults with an increased fall risk. Our findings indicate that the In Balance intervention was dominant (more effective and less costly) over general physical activity recommendations, although the differences in total societal costs and effects were not statistically significant. The probability that the In Balance intervention is cost-effective compared to the control is 98% at a WTP threshold of €0 per unit of effect gained in the main analysis. Results stratified for non- and pre-frail older adults did not differ from the results for the total group. Our study aligns with other recent trial-based CEAs and CUAs of multifactorial fall prevention interventions, which in general show no statistically significant differences in cost and effect outcomes (255, 256, 272). The differences in effect outcomes in our study were slightly more positive than in these previous studies. Also, our study showed that costs in the In Balance group were lower than in the control group, which contrasts with previous studies (255, 256, 272). The more favorable results in our study may be attributed to the intervention’s greater intensity—training participants for two hours per week—compared to the monthly in-home visits by fall-prevention specialists in the study by Isaranuwatchai et al (255). Compared to Matchar et al, our study population appears to be healthier and less frail, a factor they suggest is associated with a higher probability of cost-effectiveness (256). However, this is not confirmed by our study, since the number of prevented falls and fall-related injuries, and societal costs were similar in the non-frail and pre-frail groups. Since specific WTP thresholds for prevented falls and injuries have not yet been established by policy makers and health institutions, we used a WTP threshold of €10,000 per prevented fall-related injury, based on the estimated average healthcare costs of €9,370 per fall among individuals who visit the emergency department because of a fall-related injury (133). However, this WTP threshold might be too high, since fall-related injuries predominantly consist of minor injuries (10, 249), and costs associated with fall-related injuries are generally lower than those requiring treatment at an emergency department (251). According to the Dutch Integral Care Agreement (ICA), municipalities are responsible for implementing fall prevention interventions within a chain approach (57). This approach
RkJQdWJsaXNoZXIy MjY0ODMw