{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:23:48Z","timestamp":1755224628589,"version":"3.43.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T00:00:00Z","timestamp":1754179200000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Three pathways exist for community-based falls prevention: reactive (R), after a fall requiring medical attention; proactive (P), after professional referral of high-risk individuals; and self-referred (SR), voluntary intervention enrolment. The UK guidelines recommend scale-up of all three [\u2018recommended care\u2019 (RC)], but scale-up of none [\u2018usual care\u2019 (UC)], one (R, P, SR) or two (R+P, R+SR, P+SR) are potential options. This study aims to compare the options in terms of efficiency and equity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Cost-utility analysis from the societal perspective over a 40-year horizon identified the optimal strategy based on efficiency alone. Probabilistic sensitivity analysis accounted for parameter uncertainty. Efficiency and equity were jointly evaluated by distributional cost-effectiveness analysis. Alternative scenarios assessed changes in frailty, cognitive impairment, intervention demand and GP access.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Public sector cost-effectiveness threshold would need to exceed \u00a330\u00a0000 per quality-adjusted life year (QALY) gained for RC to have the highest probability of being cost-effective. R and R+SR were cost-effective, with costs per QALY gained of \u00a32365 (R versus UC) and \u00a35516 (R+SR versus R). RC was cost-ineffective, incurring \u00a334\u00a0258 per QALY gained versus R+SR. Other strategies were dominated. However, if decision-makers had the same relative health inequality aversion level as the English general public, RC was optimal in terms of efficiency and equity at threshold of \u00a330\u00a0000 per QALY gained. Scenarios of worse geriatric health favoured RC.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Both efficiency and relative health inequality need to be considered for the UK guideline-recommended falls prevention to be optimal versus other permutations of community-based strategies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afaf212","type":"journal-article","created":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T14:27:37Z","timestamp":1754231257000},"source":"Crossref","is-referenced-by-count":0,"title":["Efficiency and equity of community-based falls prevention pathways: a model-based health economic evaluation"],"prefix":"10.1093","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2860-7280","authenticated-orcid":false,"given":"Joseph","family":"Kwon","sequence":"first","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building , Woodstock Road, Oxford OX2 6GG ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hazel","family":"Squires","sequence":"additional","affiliation":[{"name":"Sheffield Centre for Health and Related Research, The University of Sheffield , Sheffield ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracey","family":"Young","sequence":"additional","affiliation":[{"name":"Sheffield Centre for Health and Related Research, The University of Sheffield , Sheffield ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,8,3]]},"reference":[{"key":"2025081218173176800_ref1","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1186\/s12877-020-01802-6","article-title":"Mediating factors on the association between fear of falling and health-related quality of life in community-dwelling German older people: a cross-sectional study","volume":"20","author":"Gottschalk","year":"2020","journal-title":"BMC Geriatr"},{"key":"2025081218173176800_ref2","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1007\/s00198-008-0753-5","article-title":"The health-related quality of life and cost implications of falls in elderly women","volume":"20","author":"Iglesias","year":"2009","journal-title":"Osteoporos Int"},{"key":"2025081218173176800_ref3","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1093\/ageing\/afm021","article-title":"Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people","volume":"36","author":"Zijlstra","year":"2007","journal-title":"Age Ageing"},{"key":"2025081218173176800_ref4","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1016\/j.jad.2020.12.026","article-title":"Experiences of falling and depression: Results from the Korean longitudinal study of ageing","volume":"281","author":"Kim","year":"2021","journal-title":"J Affect Disord"},{"key":"2025081218173176800_ref5","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1111\/jgs.12071","article-title":"Fall-associated difficulty with activities of daily living in functionally independent individuals aged 65 to 69 in the United States: a cohort study","volume":"61","author":"Sekaran","year":"2013","journal-title":"J Am Geriatr Soc"},{"key":"2025081218173176800_ref6","doi-asserted-by":"publisher","first-page":"104115","DOI":"10.1016\/j.archger.2020.104115","article-title":"The onset of falls reduces perceived autonomy among middle aged and older adults. 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