28 research outputs found

    One-way sensitivity analysis: tornado plot for pooled subtypes for the age group 50–54 y.

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    <p>One-way sensitivity analysis: tornado plot for pooled subtypes for the age group 50–54 y.</p

    Overall survival.

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    <p>Curves indicate model outputs. Diamond and triangle markers indicate reported 10-y OS from the N9831 and B-31 trials [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002067#pmed.1002067.ref006" target="_blank">6</a>].</p

    Base-case incremental QALYs<sup>DW</sup> and costs (2011 New Zealand dollars) per woman treated and ICERs (2011 New Zealand dollars), by age group and subtype.

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    <p>Base-case incremental QALYs<sup>DW</sup> and costs (2011 New Zealand dollars) per woman treated and ICERs (2011 New Zealand dollars), by age group and subtype.</p

    Intervention costs by population group offered the home safety assessment and modification (HSAM) intervention (age-group and injurious fall history).

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    <p>Intervention costs by population group offered the home safety assessment and modification (HSAM) intervention (age-group and injurious fall history).</p

    Analyses by ethnicity and sex within the base-case model for the home safety assessment and modification (HSAM) intervention in the Counties Manukau District Health Board (95%UI).

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    <p>Analyses by ethnicity and sex within the base-case model for the home safety assessment and modification (HSAM) intervention in the Counties Manukau District Health Board (95%UI).</p

    Home modification to reduce falls at a health district level: Modeling health gain, health inequalities and health costs

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    <div><p>Background</p><p>There is some evidence that home safety assessment and modification (HSAM) is effective in reducing falls in older people. But there are various knowledge gaps, including around cost-effectiveness and also the impacts at a health district-level.</p><p>Methods and findings</p><p>A previously established Markov macro-simulation model built for the whole New Zealand (NZ) population (Pega et al 2016, <i>Injury Prevention</i>) was enhanced and adapted to a health district level. This district was Counties Manukau District Health Board, which hosts 42,000 people aged 65+ years. A health system perspective was taken and a discount rate of 3% was used for both health gain and costs. Intervention effectiveness estimates came from a systematic review, and NZ-specific intervention costs were extracted from a randomized controlled trial.</p><p>In the 65+ age-group in this health district, the HSAM program was estimated to achieve health gains of 2800 quality-adjusted life-years (QALYs; 95% uncertainty interval [UI]: 547 to 5280). The net health system cost was estimated at NZ8.44million(958.44 million (95% UI: 663 to 14.3million).Theincrementalcosteffectivenessratio(ICER)wasestimatedatNZ14.3 million). The incremental cost-effectiveness ratio (ICER) was estimated at NZ5480 suggesting HSAM is cost-effective (95%UI: cost saving to NZ15,300[equivalenttoUS15,300 [equivalent to US10,300]). Targeting HSAM only to people age 65+ or 75+ with previous injurious falls was estimated to be particularly cost-effective (ICERs: 700and700 and 832, respectively) with the latter intervention being cost-saving. There was no evidence for differential cost-effectiveness by sex or by ethnicity: Māori (Indigenous population) vs non-Māori.</p><p>Conclusions</p><p>This modeling study suggests that a HSAM program could produce considerable health gain and be cost-effective for older people at a health district level. Nevertheless, comparisons may be desirable with other falls prevention interventions such as group exercise programs, which also provide social contact and may prevent various chronic diseases.</p></div
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