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UBC Theses and Dissertations

Health economic studies : a focus on health related quality of life, health resource utilization and falls prevention in vulnerable community dwelling seniors Davis, Jennifer Colleen


Introduction: This thesis comprises six studies that address important economic issues related to falls prevention in community living seniors. Aims: 1) To ascertain the economic burden of falls in different countries and examine why these costs differ. 2) To determine which falls prevention strategies provide the best value for money. 3) and 4) To estimate the cost-effectiveness and cost-utility of once and twice weekly resistance training compared with balance and tone classes for one year and two years in terms of falls prevented and quality adjusted life years (QALYs) gained. 5) To: a) quantify the difference in the incremental cost-effectiveness ratio (ICER) when the QALYs are generated from the EuroQol 5D (EQ-5D) and from the Short Form 6D (SF-6D) over the 12-month intervention period of the Brain Power study, b) determine key predictors of changes in health related quality of life and health resource utilization. 6) To determine whether executive functions are independently associated with health related quality of life in older women. Methods: I conducted two systematic reviews, two comprehensive cost-effectiveness and cost-utility analyses, a comparison of two generic preference based utility instruments and an exploratory study of the association between QALYs and cognition. Results: 1) The mean cost of falls ranged from US $3476 per faller to US $26 483 per fall requiring hospitalization. 2) The best value for money in falls prevention comes from interventions targeting high-risk groups. 3) Once weekly and twice weekly resistance training were cost saving compared with balance and tone classes (comparator). 4) The benefits in the year after participating were not sustained for both resistance training groups. 5) ICERs estimated from the SF-6D and EQ-5D may result in different conclusions. 6) Executive function is an independent predictor of QALYs in older women. Summary: Falls prevention strategies can be cost saving and are related to quality of life and executive function in specific groups of community dwelling seniors. Establishing consistency in economic evaluation methods is a priority for comparison of costs, QALYs and value for money between countries and between effective falls prevention strategies.

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