6 The cost-effectiveness of the Dutch In Balance fall prevention intervention | 119 includes detection, screening, intervention application, and follow-up exercise interventions to prevent falls. Although the small and statistically non-significant effects on falls and injuries of In Balance in this study should be borne in mind, the high probability of cost-effectiveness may indicate that In Balance is a promising intervention to include in the chain approach (254). Future research should explore how the effectiveness of In Balance can be increased, but also whether In Balance as part of a comprehensive fall prevention strategy is cost-effective, considering its integration within the entire chain approach. A strength of this study was that this economic evaluation was conducted alongside a randomized controlled trial across the Netherlands, in large cities and in small villages, providing a good representation of the context and population of the In Balance intervention. Second, this study included several outcome measures such as falls, fall-related injuries and quality of life, resulting in a comprehensive view of the intervention’s effectiveness. Lastly, missing data were imputed by multiple imputation to take selective missing data into account to prevent bias. A limitation of this study was that the effect of the intervention between the two groups was smaller than the difference that we assumed in our power calculation. We expected a decrease of 50% in falls after the intervention, whereas in our study the actual decrease in falls was 15%, suggesting that the sample size might not have been large enough to detect statistically significant differences in effects (254). Because of the skewed distribution of costs even larger sample sizes are needed, making our study underpowered to detect a significant difference in costs. Moreover, although we used an optimal number of 12 participants per group in our calculation of intervention costs per person, there were fewer participants than 12 in several of the groups, resulting in higher costs of the In Balance intervention. CONCLUSION The In Balance fall prevention intervention was dominant (i.e., on average more effective and less expensive) over general physical activity recommendations (control), although the differences in costs and effects between the In Balance intervention and the control group were not statistically significant. At a willingness to pay threshold of €0 per unit of effect gained, the In Balance intervention showed a high probability of 98% cost-effectiveness, which was due to the lower mean societal costs in the In Balance group.
RkJQdWJsaXNoZXIy MjY0ODMw