170 | Chapter 8 (Cost-)effectiveness and feasibility of other fall prevention interventions compared to In Balance While this thesis focussed on the In Balance intervention, other interventions have assessed on similar (cost-)effectiveness aspects such as the Otago Exercise Programme, the Nijmegen falls prevention program, and StandingTall. For example, Otago has demonstrated a 35% reduction in fall incidence, particularly among men, and was considered cost-effective compared to controls, with a positive return on investment (ROI, a metric that quantifies the profitability of an investment by comparing its net gain to its initial cost) of 36% for individuals aged 65 and older and 127% for those aged 80 and older (333-335). Otago requires minimal equipment and is accessible to community-dwelling seniors (333-335). The Nijmegen falls prevention program, while less extensively studied than Otago, has shown promise in reducing fall risks and improving balance (54). In contrast to Otago, specific data on the cost-effectiveness and feasibility are limited, possibly due to its more localized implementation and focus on specific populations (54). StandingTall, a digital intervention, has been proven effective in reducing falls and is considered cost-effective compared to controls (usual care) with a 74% probability of being cost-effective at a willingness to pay threshold of $10,000 per fall prevented (277, 336). Its feasibility is enhanced because the program could be followed in the home environment, which increases accessibility and adherence among older adults (277). While In Balance’s group format fosters social support and motivation, adherence rates are generally higher in programs that include home visits or telephone support, such as Otago (337). In this regard, while In Balance does not appear as effective as Otago in terms of fall reduction, its broader applicability to a wider range of older adults and the cost-effectiveness demonstrated in this thesis suggest its potential as a scalable intervention. Conversely, StandingTall’s digital, home-based approach offers flexibility and accessibility for non-frail individuals but may lack the face-to-face and peer support that enhances effectiveness in hands-on programs like In Balance. Practical implications MBvO instructors Given the scarcity of healthcare resources, the need for efficient and well-organized fall prevention programs becomes increasingly urgent (338). These fall prevention programs play a vital role in reducing the incidence of falls, which in turn helps to alleviate the burden on healthcare systems by reducing hospitalizations, medical treatments, and long-term care requirements related to falls (339). In our study, physiotherapists and exercise therapists provided the intervention. However, in practice, sport and health coaches, such as MBvO instructors (Meer Bewegen voor Ouderen, translated as More Movement for Older Adults), also deliver fall prevention interventions. Physical and exercise therapists are more expensive
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