Osteoporosis International

, Volume 21, Issue 8, pp 1295–1306 | Cite as

International comparison of cost of falls in older adults living in the community: a systematic review

  • J. C. Davis
  • M. C. Robertson
  • M. C. Ashe
  • T. Liu-Ambrose
  • K. M. Khan
  • C. A. Marra
Review

Abstract

Summary

Our objective was to determine international estimates of the economic burden of falls in older people living in the community. Our systematic review emphasized the need for a consensus on methodology for cost of falls studies to enable more accurate comparisons and subgroup-specific estimates among different countries.

Introduction

The purpose of this study was to determine international estimates of the economic burden of falls in older people living in the community.

Methods

This is a systematic review of peer-reviewed journal articles reporting estimates for the cost of falls in people aged ≥60 years living in the community. We searched for papers published between 1945 and December 2008 in MEDLINE, PUBMED, EMBASE, CINAHL, Cochrane Collaboration, and NHS EED databases that identified cost of falls in older adults. We extracted the cost of falls in the reported currency and converted them to US dollars at 2008 prices, cost items measured, perspective, time horizon, and sensitivity analysis. We assessed the quality of the studies using a selection of questions from Drummond’s checklist.

Results

Seventeen studies met our inclusion criteria. Studies varied with respect to viewpoint of the analysis, definition of falls, identification of important and relevant cost items, and time horizon. Only two studies reported a sensitivity analysis and only four studies identified the viewpoint of their economic analysis. In the USA, non-fatal and fatal falls cost US $23.3 billion (2008 prices) annually and US $1.6 billion in the UK.

Conclusions

The economic cost of falls is likely greater than policy makers appreciate. The mean cost of falls was dependent on the denominator used and ranged from US $3,476 per faller to US $10,749 per injurious fall and US $26,483 per fall requiring hospitalization. A consensus on methodology for cost of falls studies would enable more accurate comparisons and subgroup-specific estimates among different countries.

Keywords

Cost Economic analysis Fall Older adults Systematic review 

Notes

Acknowledgments

Jennifer C. Davis is funded by a Michael Smith Foundation for Health Research Senior Graduate Studentship, a Canadian Institute for Health Research Canada Graduate Scholarship, and the Centre for Hip Health and Mobility. Maureen C. Ashe and Teresa Liu-Ambrose are funded by a Michael Smith Foundation for Health Research Scholar Award. Carlo A. Marra is funded by a Canada Research Chair in Pharmaceutical Outcomes and a Michael Smith Foundation for Health Research Scholar Award.

Author contributions

Jennifer C. Davis, M. Clare Robertson, Maureen C. Ashe: Study concept and design, extraction of data, analysis and interpretation of data, preparation of manuscript, and critical review of manuscript. Teresa Liu-Ambrose, Carlo A. Marra, and Karim M. Khan: Study concept and design, analysis and interpretation of data, preparation of manuscript, and critical review of manuscript.

Conflicts of interest

None.

References

  1. 1.
    Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337:1279–1284CrossRefPubMedGoogle Scholar
  2. 2.
    Campbell AJ, Borrie MJ, Spears GF (1989) Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 44:M112–M117PubMedGoogle Scholar
  3. 3.
    Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707PubMedGoogle Scholar
  4. 4.
    National Center for Injury Prevention and Control (1998) National Center for Injury Prevention and Control: statistics and activities. Int J Trauma Nurs 4:18–22Google Scholar
  5. 5.
    Sattin RW, Lambert Huber DA, DeVito CA, Rodriguez JG, Ros A, Bacchelli S, Stevens JA, Waxweiler RJ (1990) The incidence of fall injury events among the elderly in a defined population. Am J Epidemiol 131:1028–1037PubMedGoogle Scholar
  6. 6.
    Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA (2009) Does a home-based strength and balance programme in people aged ≥80 years provide the best value for money to prevent falls? A systematic review of economic analyses of falls prevention interventions. Br J Sports Med. 6 Aug 2009 (Epub ahead of print). doi: 10.1136/bjsm.2009.060988
  7. 7.
    Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 354:1896–1900CrossRefPubMedGoogle Scholar
  8. 8.
    Drummond MF, Sculpher MJ, Torrance GW, O'Brien B, Stoddart GL (2005) Methods for the economic evaluation of health care programmes, 3rd edn. Oxford University Press, New YorkGoogle Scholar
  9. 9.
    US Department of Labour. www.bls.gov/data/, accessed July 2009
  10. 10.
    Welte R, Feenstra T, Jager H, Leidl R (2004) A decision chart for assessing and improving the transferability of economic evaluation results between countries. Pharmacoeconomics 22:857–876CrossRefPubMedGoogle Scholar
  11. 11.
    Englander F, Hodson TJ, Terregrossa RA (1996) Economic dimensions of slip and fall injuries. J Forensic Sci 41:733–746PubMedGoogle Scholar
  12. 12.
    Carroll NV, Slattum PW, Cox FM (2005) The cost of falls among the community-dwelling elderly. J Manag Care Pharm 11:307–316PubMedGoogle Scholar
  13. 13.
    Rizzo JA, Friedkin R, Williams CS, Nabors J, Acampora D, Tinetti ME (1998) Health care utilization and costs in a Medicare population by fall status. Med Care 36:1174–1188CrossRefPubMedGoogle Scholar
  14. 14.
    Stevens JA, Corso PS, Finkelstein EA, Miller TR (2006) The costs of fatal and non-fatal falls among older adults. Inj Prev 12:290–295CrossRefPubMedGoogle Scholar
  15. 15.
    Finkelstein EA, Chen H, Miller TR, Corso PS, Stevens JA (2005) A comparison of the case–control and case–crossover designs for estimating medical costs of nonfatal fall related injuries among older Americans. Med Care 43:1087–1091CrossRefPubMedGoogle Scholar
  16. 16.
    Alexander BH, Rivara FP, Wolf ME (1992) The cost and frequency of hospitalization for fall related injuries in older adults. Am J Public Health 82:1020–1023CrossRefPubMedGoogle Scholar
  17. 17.
    Roudsari BS, Ebel BE, Corso PS, Molinari NA, Koepsell TD (2005) The acute medical care costs of fall related injuries among the U.S. older adults. Injury 36:1316–1322CrossRefPubMedGoogle Scholar
  18. 18.
    Ellis AA, Trent RB (2001) Do the risks and consequences of hospitalized fall injuries among older adults in California vary by type of fall? J Gerontol A Biol Sci Med Sci 56:M686–M692PubMedGoogle Scholar
  19. 19.
    Mahoney JE, Glysch RL, Guilfoyle SM, Hale LJ, Katcher ML (2005) Trends, risk factors, and prevention of falls in older adults in Wisconsin. WMJ 104:22–28PubMedGoogle Scholar
  20. 20.
    Newton JL, Kyle P, Liversidge P, Robinson G, Wilton K, Reeve P (2006) The costs of falls in the community to the North East Ambulance Service. Emerg Med J 23:479–481CrossRefPubMedGoogle Scholar
  21. 21.
    Scuffham P, Chaplin S, Legood R (2003) Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health 57:740–744CrossRefPubMedGoogle Scholar
  22. 22.
    Hall SE, Hendrie DV (2003) A prospective study of the costs of falls in older adults living in the community. Aust N Z J Public Health 27:343–351CrossRefPubMedGoogle Scholar
  23. 23.
    Hendrie D, Hall SE, Arena G, Legge M (2004) Health system costs of falls of older adults in Western Australia. Aust Health Rev 28:363–373CrossRefPubMedGoogle Scholar
  24. 24.
    Seematter-Bagnoud L, Wietlisbach V, Yersin B, Bula CJ (2006) Healthcare utilization of elderly persons hospitalized after a noninjurious fall in a Swiss academic medical center. J Am Geriatr Soc 54:891–897CrossRefPubMedGoogle Scholar
  25. 25.
    Cotter PE, Timmons S, O’Connor M, Twomey C, O'Mahony D (2006) The financial implications of falls in older people for an acute hospital. Ir J Med Sci 175:11–13CrossRefPubMedGoogle Scholar
  26. 26.
    Panneman MJ, Goettsch WG, Kramarz P, Herings RM (2003) The costs of benzodiazepine-associated hospital-treated fall injuries in the EU: a Pharmo Study. Drugs Aging 20:833–839CrossRefPubMedGoogle Scholar
  27. 27.
    Sjogren H, Bjornstig U (1991) Trauma in the elderly: the impact on the health care system. Scand J Prim Health Care 9:203–207CrossRefPubMedGoogle Scholar
  28. 28.
    Bansback N, Ara R, Ward S, Anis A, Choi HK (2009) Statin therapy in rheumatoid arthritis: a cost-effectiveness and value-of-information analysis. Pharmacoeconomics 27:25–37CrossRefPubMedGoogle Scholar
  29. 29.
    Mycek S (2004) The dire cost of obesity. Mater Manag Health Care 13:18–21PubMedGoogle Scholar
  30. 30.
    Drummond MF, Barbieri M, Cook J, Glick HA, Lis J, Malik F, Reed S, Rutten F, Sculpher M, Severens J (2009) Transferability of economic evaluations across jurisdictions: ISPOR Good Research Practices Task Force Report. Value Health 12:409–418CrossRefPubMedGoogle Scholar
  31. 31.
    Yabroff KR, Warren JL, Banthin J, Schrag D, Mariotto A, Lawrence W, Meekins A, Topor M, Brown ML (2009) Comparison of approaches for estimating prevalence costs of care for cancer patients: what is the impact of data source? Med Care 47:S64–S69CrossRefPubMedGoogle Scholar
  32. 32.
    Yabroff KR, Warren JL, Schrag D, Mariotto A, Meekins A, Topor M, Brown ML (2009) Comparison of approaches for estimating incidence costs of care for colorectal cancer patients. Med Care 47:S56–S63CrossRefPubMedGoogle Scholar
  33. 33.
    Koopmanschap MA (1998) Cost-of-illness studies. Useful for health policy? Pharmacoeconomics 14:143–148CrossRefPubMedGoogle Scholar
  34. 34.
    Hodgson TA, Meiners MR (1982) Cost-of-illness methodology: a guide to current practices and procedures. Milbank Mem Fund Q Health Soc 60:429–462CrossRefPubMedGoogle Scholar
  35. 35.
    Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews Issue 2. Art.No.:CD007146. doi: 10.1002/14651858.CD007146.pub2

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • J. C. Davis
    • 1
  • M. C. Robertson
    • 2
  • M. C. Ashe
    • 1
  • T. Liu-Ambrose
    • 1
  • K. M. Khan
    • 1
  • C. A. Marra
    • 3
  1. 1.Centre for Hip Health and MobilityUniversity of British ColumbiaVancouverCanada
  2. 2.Department of Medical & Surgical Sciences, Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
  3. 3.Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverCanada

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