Dosage for cost-effective exercise-based falls prevention programs for older people: A systematic review of economic evaluations

Background: Falls in older people is a global public health concern. Physical exercise is a useful and potentially cost-saving treatment option to prevent falls in older people. Objectives: We aimed to (1) summarize the research literature regarding the cost-effectiveness of exercise-based programs for falls prevention in older people and (2) discuss the implications of the review's findings for clinical practice and future research on the dosage of cost-effective exercise-based falls prevention programs for older people. Methods: Multiple databases were searched from inception until February 2019. Studies were included if they (1) were randomized controlled trials with an economic evaluation of exercise-based falls prevention programs for people ≥ 60 years old and (2) assessed the incremental cost-effectiveness ratios, cost per quality-adjusted life year, incremental cost per fall and benefit-to-cost ratio of programs. Methodological quality was assessed with the Physiotherapy Evidence Database scale and quality of economic evaluation with the Quality of Health Economic Studies. Results: We included 12 studies (3668 older people). Interventions for falls prevention were either exercise-only or multifactorial programs. Five studies of high economic quality and 2 of high methodological quality provided evidence supporting exercise-only programs as cost-effective for preventing falls in older people. Specifically, a tailored exercise program including strengthening of lower extremities, balance training, cardiovascular exercise, stretching and functional training of moderate intensity performed twice per week with each session lasting 60 min for ≥ 6 months delivered in groups of 3 to 8 participants with home-based follow-up appears to be cost-effective in preventing falls in older people. Conclusion: There is evidence to support exercise-based interventions as cost-effective treatment for preventing falls. Further research is needed to fully establish the cost-effectiveness of such programs, especially in both developing and underdeveloped countries. Review registration: PROSPERO CRD42018102892.