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. KhanEmail author
  • C. A. Marra



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.


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


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.


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.


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.


Cost Economic analysis Fall Older adults Systematic review 



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



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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
    Email author
  • 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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