The Cost-benefit Analysis of Home Environmental Improvement to Prevent Elderly Falls

ASIA unversity > 醫學暨健康學院 > 健康產業管理學系 > 長期照護組 > 博碩士論文 > Item 310904400/2393

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题名:	The Cost-benefit Analysis of Home Environmental Improvement to Prevent Elderly Falls
作者:	Mei-lien Tang
贡献者:	Department of Healthcare Administration/Healthcare Division
关键词:	elderly fall;home environmental improvement;medical expenditure,;decision tree,;cost benefit analysis
日期:	2008
上传时间:	2009-11-06 05:37:11 (UTC+0)
摘要:	Unintentional falls are a common occurrence and a major cause of unintentional death among older adults. Approximately one third of persons aged 65 and above fell at least once a year. 50% of those who fell might fell again. Falls may result in both minor injuries, such as bruises or abrasions, and serious injuries, such as head injury, fracture or other serious soft tissue injuries. Impairement and disable activity function resulted in fall-releated injuries, which increase in the needs of long term care. The impact of eldeerly falls is not only augmentation of medical expenditure but also social economic cost. Fall-related injuries accounted for 6% of all medical expenditures among elderly age 65 and above in the United States. Effectively fall preventive strategies could reduce incidence of elderly falls, such as regular exercise, appropriciate nutrition, regular reassessment of drugs, home improvement and behavioral education. Prevention of falls is likely to lessen disability, dependence and loss of life. The fall-related medical expenditure is also decreased with fewer injurious falls. According to literatures, the fewer studies concerned with cost-benefit of preventive programs. The aim of this study is to find out the cost benefit of home environmental improvement to prevent elderly falls from the perspective of the public sector. The cost benefit of home environmental improvement was analyzed by using a decision analytic model. The cost data included home environmental assessment and modification, and the data was from literature or government subsidy in Taiwan. The benefit data was the extent of the decline of fall-related medical expenditures after the intervention. By using secondary data, the medical expenditure of fall-related injuries was analyzed. The parameters of our decision model were determined on available data from the published literature, the priority on Taiwanese data. Cost-benefit ratio was estimated as the cost per one unit fall-related expenditure prevented. The result of fall-related medical expenditure among the elder aged 65 and above was NT$40,372. Fractures were the most common fall-related injury and the propotion of femoral neck fracture was the highest. According to the decision model, the national fall-related medical expenditure was NT$5.14 billion and it decreased in NT$2.25 billion after home improvement. At the estimation of national cost of intervention, NT$19.2 billion, the cost-benefit ratio was -8.57. It meant that the cost per fall-related medical expenditure prevented was NT$8.57. If the propotion of execution for home improvement was 10%, the CB ratio was less than NT$1. This indicated benefit was greater than cost. This study only took into account the fall-related medical expenditure without considering the long-term-care cost, the time cost or the quality of life of the elderly and the productivity or time loss of cargeiver; hence the total economic cost of the falls might be underestimated. And then the results of the cost benefit analysis are based on a model constructed from various data sources and assumptions, further research is required to provide evidence-based data before definitive policy conclusions.
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