Impact of five tobacco endgame strategies on future smoking prevalence, population health and health system costs: two modelling studies to inform the tobacco endgame

2017 ◽  
Vol 27 (3) ◽  
pp. 278-286 ◽  
Author(s):  
Frederieke S van der Deen ◽  
Nick Wilson ◽  
Christine L Cleghorn ◽  
Giorgi Kvizhinadze ◽  
Linda J Cobiac ◽  
...  
Keyword(s):  
Smoking Prevalence ◽  
Health Gain ◽  
Cost Savings ◽  
Uncertainty Interval ◽  
Health Gains ◽  
Life Years ◽  
Tobacco Tax ◽  
Population Forecasting ◽  
Modelling Studies ◽  
Tobacco Endgame

ObjectiveThere is growing international interest in advancing ‘the tobacco endgame’. We use New Zealand (Smokefree goal for 2025) as a case study to model the impacts on smoking prevalence (SP), health gains (quality-adjusted life-years (QALYs)) and cost savings of (1) 10% annual tobacco tax increases, (2) a tobacco-free generation (TFG), (3) a substantial outlet reduction strategy, (4) a sinking lid on tobacco supply and (5) a combination of 1, 2 and 3.MethodsTwo models were used: (1) a dynamic population forecasting model for SP and (2) a closed cohort (population alive in 2011) multistate life table model (including 16 tobacco-related diseases) for health gains and costs.ResultsAll selected tobacco endgame strategies were associated with reductions in SP by 2025, down from 34.7%/14.1% for Māori (indigenous population)/non-Māori in 2011 to 16.0%/6.8% for tax increases; 11.2%/5.6% for the TFG; 17.8%/7.3% for the outlet reduction; 0% for the sinking lid; and 9.3%/4.8% for the combined strategy. Major health gains accrued over the remainder of the 2011 population’s lives ranging from 28 900 QALYs (95% Uncertainty Interval (UI)): 16 500 to 48 200; outlet reduction) to 282 000 QALYs (95%UI: 189 000 to 405 000; sinking lid) compared with business-as-usual (3% discounting). The timing of health gain and cost savings greatly differed for the various strategies (with accumulated health gain peaking in 2040 for the sinking lid and 2070 for the TFG).ConclusionsImplementing endgame strategies is needed to achieve tobacco endgame targets and reduce inequalities in smoking. Given such strategies are new, modelling studies provide provisional information on what approaches may be best.

Impact of increasing tobacco taxes on working-age adults: short-term health gain, health equity and cost savings

2017 ◽  
Vol 27 (e2) ◽  
pp. e167-e170 ◽  
Author(s):  
Christine L Cleghorn ◽  
Tony Blakely ◽  
Giorgi Kvizhinadze ◽  
Frederieke S van der Deen ◽  
Nhung Nghiem ◽  
...  
Keyword(s):  
Time Horizon ◽  
Health Gain ◽  
Cost Savings ◽  
Age Group ◽  
Tobacco Taxes ◽  
Health Gains ◽  
Life Years ◽  
Tobacco Tax ◽  
Working Age ◽  
The Impact

ObjectiveThe health gains and cost savings from tobacco tax increase peak many decades into the future. Policy-makers may take a shorter-term perspective and be particularly interested in the health of working-age adults (given their role in economic productivity). Therefore, we estimated the impact of tobacco taxes in this population within a 10-year horizon.MethodsAs per previous modelling work, we used a multistate life table model with 16 tobacco-related diseases in parallel, parameterised with rich national data by sex, age and ethnicity. The intervention modelled was 10% annual increases in tobacco tax from 2011 to 2020 in the New Zealand population (n=4.4 million in 2011). The perspective was that of the health system, and the discount rate used was 3%.ResultsFor this 10-year time horizon, the total health gain from the tobacco tax in discounted quality-adjusted life years (QALYs) in the 20–65 year age group (age at QALY accrual) was 180 QALYs or 1.6% of the lifetime QALYs gained in this age group (11 300 QALYs). Nevertheless, for this short time horizon: (1) cost savings in this group amounted to NZ$10.6 million (equivalent to US$7.1 million; 95% uncertainty interval: NZ$6.0 million to NZ$17.7 million); and (2) around two-thirds of the QALY gains for all ages occurred in the 20–65 year age group. Focusing on just the preretirement and postretirement ages, the QALY gains in each of the 60–64 and 65–69 year olds were 11.5% and 10.6%, respectively, of the 268 total QALYs gained for all age groups in 2011–2020.ConclusionsThe majority of the health benefit over a 10-year horizon from increasing tobacco taxes is accrued in the working-age population (20–65 years). There remains a need for more work on the associated productivity benefits of such health gains.

Restricting tobacco sales to only pharmacies combined with cessation advice: a modelling study of the future smoking prevalence, health and cost impacts

2018 ◽  
Vol 28 (6) ◽  
pp. 643-650 ◽  
Author(s):  
Frederieke S Petrović-van der Deen ◽  
Tony Blakely ◽  
Giorgi Kvizhinadze ◽  
Christine L Cleghorn ◽  
Linda J Cobiac ◽  
...  
Keyword(s):  
Population Health ◽  
Smoking Prevalence ◽  
Large Population ◽  
Simulation Models ◽  
Intervention Package ◽  
Future Health ◽  
Uncertainty Interval ◽  
Tobacco Sales ◽  
Life Years ◽  
Tobacco Endgame

ObjectiveRestricting tobacco sales to pharmacies only, including the provision of cessation advice, has been suggested as a potential measure to hasten progress towards the tobacco endgame. We aimed to quantify the impacts of this hypothetical intervention package on future smoking prevalence, population health and health system costs for a country with an endgame goal: New Zealand (NZ).MethodsWe used two peer-reviewed simulation models: 1) a dynamic population forecasting model for smoking prevalence and 2) a closed cohort multi-state life-table model for future health gains and costs by sex, age and ethnicity. Greater costs due to increased travel distances to purchase tobacco were treated as an increase in the price of tobacco. Annual cessation rates were multiplied with the effect size for brief opportunistic cessation advice on sustained smoking abstinence.ResultsThe intervention package was associated with a reduction in future smoking prevalence, such that by 2025 prevalence was 17.3%/6.8% for Māori (Indigenous)/non-Māori compared to 20.5%/8.1% projected under no intervention. The measure was furthermore estimated to accrue 41 700 discounted quality-adjusted life-years (QALYs) (95% uncertainty interval (UI): 33 500 to 51 600) over the remainder of the 2011 NZ population’s lives. Of these QALYs gained, 74% were due to the provision of cessation advice over and above the limiting of sales to pharmacies.ConclusionsThis work provides modelling-level evidence that the package of restricting tobacco sales to only pharmacies combined with cessation advice in these settings can accelerate progress towards the tobacco endgame, and achieve large population health benefits and cost-savings.

Abstract 057: Estimating the Benefits of the Proposed FDA Sodium Reformulation Policy on Cardiovascular Disease, Disparities and Economic Costs

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Jonathan Pearson-Stuttard ◽  
Chris Kypridemos ◽  
Brendan Collins ◽  
Yue Huang ◽  
Piotr Bandosz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
Sodium Reduction ◽  
Uncertainty Interval ◽  
Population Total ◽  
Health Gains ◽  
Life Years ◽  
The Us ◽  
Hispanic White

Background: Sodium consumption is a leading modifiable risk factor for CVD mortality and morbidity in the US. In 2016, the US Food and Drug Administration (FDA), following recent effective examples in several other countries, proposed voluntary sodium targets for industry to reduce sodium in processed foods. Aim: We aimed to estimate the potential CVD, equity and economic impacts of implementing this policy. Methods: We used the validated US IMPACT Food Policy microsimulation model to estimate the CVD cases averted, quality-adjusted life-years (QALYs) gained and cost-effectiveness from 2017-2036 of the FDA sodium reformulation policy in US adults (30+ years). Model inputs included national demographics and sodium intakes from NHANES, FDA short- and long-term sodium reformulation targets, sodium effects on blood pressure and of blood pressure on CVD from meta-analyses, government costs to administer and monitor the policy and industry reformulation costs, and validated healthcare and productivity costs. We modelled 3 scenarios: a) Optimal, 100% compliance of 10-year reformulation targets b) Modest, 50% compliance of 10-year reformulation targets c) Pessimistic, 100% compliance of 2-year reformulation targets with no further progress Costs were inflated to 2017 US dollars and outputs were discounted annually by 3%. We took a societal perspective for this analysis. Rigorous probabilistic sensitivity analyses were conducted. Results: The optimal scenario achieving the 10-year sodium reduction targets could prevent ~ 450,000 CVD cases (95% Uncertainty Interval: 240,000-740,000), gain 2.1 million QALYs (1.7m-2.4m), and produce $41billion ($14bn-$81bn) cost-savings from 2017-2036. The modest and pessimistic scenarios were also cost-saving, with both health gains and savings about one half and one quarter, respectively, of the optimal scenario. Relative disparities between non-Hispanic white and non-Hispanic black populations would be reduced in all scenarios. The pessimistic scenario yielded the largest reduction in absolute disparities (70,000 CVD cases (33,000-120,000) prevented in non-Hispanic blacks vs. 13,000 (0-54,000) in non-Hispanic whites). The optimal scenario would prevent approximately 4.6% (130,000 cases (65,0000-220,000)) of all CVD cases in non-Hispanic blacks compared to 1.5% (220,000 cases (120,000-360,000)) in non-Hispanic whites. Despite a smaller population, total net savings would be over 50% larger in non-Hispanic blacks than non-Hispanic whites ($19bn vs $12bn) in the optimal scenario. Conclusions: Implementing and even partly achieving the FDA sodium reduction targets could generate substantial health gains and net cost savings. Crucially, this policy could also reduce CVD disparities between non-Hispanic black and non-Hispanic white populations.

Cost-effectiveness of a two-gene urine biomarker assay in MRI strategies for the initial detection of prostate cancer.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 91-91 ◽  
Author(s):  
Tim Govers ◽  
Matthew J. Resnick ◽  
Geert Trooskens ◽  
Wim Van Criekinge ◽  
Jack A. Schalken
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Health Gain ◽  
Cost Savings ◽  
Decision Analytic Model ◽  
Model Parameters ◽  
Life Years ◽  
Clinically Significant ◽  
Using Data ◽  
Systematic Biopsy

91 Background: MRI is increasingly used in men with a suspicion for prostate cancer (PCa) to target abnormal areas next to systematic biopsy. Although, MRI increases the detection of clinically significant PCa compared to systematic biopsy alone, overdiagnosis and overtreatment of insignificant disease still exists. The 2-gene mRNA PCR urine test combined with traditional risk factors SelectMDx (MDxhealth Irvine Ca) predicts clinically significant PCa, and can be used to reduce overdiagnosis and overtreatment. We assessed the cost-effectiveness of SelectMDx in a population of U.S. men who in the current situation undergo initial MRI and biopsies. Methods: We developed a decision-analytic model to simulate the downstream outcomes in the current MRI strategy, i.e. systematic biopsy plus targeted biopsy in case of a positive MRI. SelectMDx was assessed in two different diagnostic pathways: 1) before MRI to select patients for MRI and biopsy, 2) after a negative MRI to select patients for systematic biopsy. Outcomes were quality-adjusted life years (QALYs) and costs. Model parameters were informed by literature. Two scenarios regarding the mortality of missed PCa were used, using SPCG trial data and using data from the PIVOT trial. Results: Using SelectMDx before MRI (1) resulted in a health gain of 0.003 and 0.030 QALY per patient compared to the current MRI strategy, using the SPCG and PIVOT data, respectively. Cost savings were $1590 per patient and about $496 million for the yearly population of men at risk in the U.S. (n = 311,879). SelectMDx after negative MRI (2) resulted in a health gain of 0.008 and 0,011 QALY per patient using the SPCG and PIVOT data.. Cost savings were $436 per patient and about $136 million for the yearly population. Conclusions: The use of SelectMDx to guide prostate biopsy decision-making can improve health outcomes and lower costs. Cost savings were highest when SelectMDx was used before MRI to select patients for MRI and biopsy. With respect to health gain, the use of SelectMDx after negative MRI was most beneficial when assuming higher mortality for missed PCa (SPCG). When the mortality was assumed to be lower (PIVOT) SelectMDx should be used before MRI to result in the highest health gain.

scholarly journals 1243Quantitative risk-benefit assessment of fish and seafood consumption scenarios to support recommendations

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Catarina Carvalho ◽  
Daniela Correia ◽  
Milton Severo ◽  
Cláudia Afonso ◽  
Narcisa M. Bandarra ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Health Gain ◽  
Benefit Assessment ◽  
Mercury Species ◽  
Seafood Consumption ◽  
Tolerable Weekly Intake ◽  
Health Gains ◽  
Life Years ◽  
Risk Benefit Assessment ◽  
Alternative Scenarios

Abstract Background Fish/seafood consumption has health benefits, namely due to its omega-3 fatty acids levels and risks due to methylmercury contamination. This study aims to quantify the health impact of hypothetical scenarios of fish/seafood consumption through a risk-benefit assessment and provide support for recommendations, using Portuguese food consumption data. Methods We used data from the National Food, Nutrition and Physical Activity Survey 2015-2016 (n = 5811) to estimate the mean exposure to methylmercury and EPA+DHA in the current and alternative scenarios. Alternative scenarios were modelled using probabilistic approaches to reflect substitutions from the current consumption in the type of fish/seafood (predatory vs low-mercury species) or its frequency (1-7x/week). The overall scenarios’ impact was quantified using Disability-Adjusted Life Years (DALYs). Results About 14% of the Portuguese population exceeds the methylmercury tolerable weekly intake, and this prevalence is higher among small children (36.6%). Nevertheless, if the fish/seafood consumption increased to once a day, ≈11450 DALYs could be prevented each year. However, such a scenario would result in higher risk for pregnant women (1398 extra DALYs). Moreover, excluding predatory species consumption resulted in small but significant health gains (-1078 DALYs). Conclusions For the general population, the maximum health gains are obtained by consuming fish/seafood up to 7x/week, but among children and pregnant women, the frequency should be limited to 3-5x/week. All population should preferably choose non-predatory species. Key messages Daily fish consumption results in the highest overall populational health gain, but children and pregnant women need to limit it to 3-5x/week, due to methylmercury exposure.

Health Impact and Cost-Effectiveness of Achieving the National Salt and Sugar Reduction Initiative Voluntary Sugar Reduction Targets in the United States: A Micro-Simulation Study

Circulation ◽  
2021 ◽  
Author(s):  
Siyi Shangguan ◽  
Dariush Mozaffarian ◽  
Stephen Sy ◽  
Yujin Lee ◽  
Junxiu Liu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Sensitivity Analyses ◽  
Potential Health ◽  
Added Sugar ◽  
Health Gains ◽  
Life Years ◽  
Sugar Reduction

Background: High intake of added sugar is linked to weight gain and cardiometabolic risk. In 2018, the US National Salt and Sugar Reduction Initiative (NSSRI) proposed government supported voluntary national sugar reduction targets. This intervention's potential health and equity impacts, and cost-effectiveness are unclear. Methods: A validated microsimulation model, CVD-PREDICT, coded in C++, was used to estimate incremental changes in type 2 diabetes, cardiovascular disease (CVD), quality-adjusted life-years (QALYs), costs and cost-effectiveness of the NSSRI policy. The model was run at the individual-level, incorporating the annual probability of each person's transition between health status based on their risk factors. The model incorporated national demographic and dietary data from the National Health and Nutrition Examination Survey across 3 cycles (2011-2016), added sugar-related diseases from meta-analyses, and policy costs and health-related costs from established sources. A simulated nationally representative US population was created and followed until age 100 years or death, with 2019 as the year of intervention start. Findings were evaluated over 10 years and a lifetime from healthcare and societal perspectives. Uncertainty was evaluated in a one-way analysis by assuming 50% industry compliance, and probabilistic sensitivity analyses via a second-order Monte Carlo approach. Model outputs included averted diabetes cases, CVD events and CVD deaths, QALYs gained, and formal healthcare cost savings, stratified by age, race, income and education. Results: Achieving the NSSRI sugar reduction targets could prevent 2.48 million CVD events, 0.49 million CVD deaths, and 0.75 million diabetes cases; gain 6.67 million QALYs; and save $160.88 billion net costs from a societal perspective over a lifetime. The policy became cost-effective (<150K/QALYs) at 6 years, highly cost-effective (< 50K/QALYs) at 7 years, and cost-saving at 9 years. Results were robust from a healthcare perspective, with lower (50%) industry compliance, and in probabilistic sensitivity analyses. The policy could also reduce disparities, with greatest estimated health gains per million adults among Black and Hispanic, lower income, and less educated Americans. Conclusions: Implementing and achieving the NSSRI sugar reformation targets could generate substantial health gains, equity gains and cost-savings.

Prescribing smartphone applications for physical activity promotion in primary care: modeling health gain and cost savings (Preprint)

2021 ◽  
Author(s):  
Leah Grout ◽  
Kendra Telfer ◽  
Nick Wilson ◽  
Christine Cleghorn ◽  
Anja Mizdrak
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health System ◽  
Cost Savings ◽  
Activity Levels ◽  
Smartphone Applications ◽  
Primary Care Settings ◽  
Health Gains ◽  
Life Years ◽  
Physical Activity Levels

BACKGROUND Inadequate physical activity is a substantial cause of health loss globally with this loss attributable to such diseases as coronary heart disease, diabetes, stroke, and certain forms of cancer. OBJECTIVE We aimed to assess the potential impact of the prescription of smartphone applications (apps) in primary care settings on physical activity levels, health gains (in quality-adjusted life years (QALYs)), and health system costs in New Zealand (NZ). METHODS A proportional multistate lifetable model was used to estimate the change in physical activity levels and to predict resultant health gains in QALYs and health system costs over the remaining lifespan of the NZ population alive in 2011 at a 3% discount rate. RESULTS The modeled intervention resulted in an estimated 430 QALYs (95% uncertainty interval: 320 to 550), with net cost-savings of NZ $2.2 million (2018 US $1.6 million) over the remaining lifespan of the 2011 NZ population. On a per capita basis, QALY gains were generally larger in women than men, and larger in Māori than non-Māori. The health impact and cost-effectiveness of the intervention were highly sensitive to assumptions around intervention uptake and decay. For example, the scenario analysis with the largest benefits, which assumed a five-year maintenance of additional physical activity levels, delivered 1750 QALYs and NZ $22.5 million in cost-savings. CONCLUSIONS The prescription of smartphone apps for promoting physical activity in primary care settings is likely to generate modest health gains and cost-savings at the population level, in this high-income country. Such gains may increase with ongoing improvements in app design and increased health worker promotion to patients.

Impact of tax and tobacco-free generation on health-adjusted life years in the Solomon Islands: a multistate life table simulation

2019 ◽  
pp. tobaccocontrol-2018-054861 ◽  
Author(s):  
Ankur Singh ◽  
Frederieke Sanne Petrović-van der Deen ◽  
Natalie Carvalho ◽  
Alan D Lopez ◽  
Tony Blakely
Keyword(s):  
Life Table ◽  
Smoking Prevalence ◽  
Solomon Islands ◽  
Health Gain ◽  
Potential Health ◽  
Life Years ◽  
Table Model ◽  
Life Table Model ◽  
Free Generation ◽  
Multistate Life Table

ObjectiveTo estimate health-adjusted life years (HALY) gained in the Solomon Islands for the 2016 population over the remainder of their lives, for three interventions: hypothetical eradication of cigarettes; 25% annual tax increases to 2025 such that tax represents 70% of sales price of tobacco; and a tobacco-free generation (TFG).DesignWe adapted an existing multistate life table model, using Global Burden of Disease (GBD) and other data inputs, including diseases contributing >5% of the GBD estimated disability-adjusted life years lost in the Solomon Islands in 2016. Tax effects used price increases and price elasticities to change cigarette smoking prevalence. The TFG was modelled by no uptake of smoking among those 20 years and under after 2016.ResultsUnder business as usual (BAU) smoking prevalence decreased over time, and decreased faster under the tax intervention (especially for younger ages). For example, for 20-year-old males the best estimated prevalence in 2036 was 22.9% under BAU, reducing to 14.2% under increased tax. Eradicating tobacco in 2016 would achieve 1510 undiscounted HALYs per 1000 people alive in 2016, over the remainder of their lives. The tax intervention would achieve 370 HALYs per 1000 (24.5% of potential health gain), and the TFG 798 HALYs per 1000 people (52.5%). By time horizon, 10.5% of the HALY gains from tax and 8.0% from TFG occur from 2016 to 2036, and the remainder at least 20 years into the future.ConclusionThis study quantified the potential of two tobacco control policies over maximum health gains achievable through tobacco eradication in the Solomon Islands.

scholarly journals Comparing Health Gains, Costs and Cost-Effectiveness of 100s of Interventions in Australia and New Zealand: An Online Interactive League Table

2022 ◽  
Author(s):  
Natalie Carvalho ◽  
Tanara Sousa ◽  
Anja Mizdrak ◽  
Amanda Jones ◽  
Nick Wilson ◽  
...  
Keyword(s):  
New Zealand ◽  
Cost Effectiveness ◽  
Communicable Disease ◽  
Health Gain ◽  
Overweight And Obesity ◽  
League Table ◽  
Disease Epidemiology ◽  
Health Gains ◽  
Diabetes Diet ◽  
Life Years

Abstract Background This study compares the health gains, costs, and cost-effectiveness of hundreds of Australian and New Zealand (NZ) health interventions conducted with comparable methods in an online interactive league table designed to inform policy. Methods A literature review was conducted to identify peer-reviewed evaluations (2010 to 2018) arising from the Australia Cost-Effectiveness (ACE) research and NZ Burden of Disease Epidemiology, Equity and Cost-Effectiveness (BODE3) Programmes, or using similar methodology, with: health gains quantified as health-adjusted life years (HALYs); net health system costs and/or incremental cost-effectiveness ratio; time horizon of at least 10 years; and 3–5% discount rates. Results We identified 384 evaluations that met the inclusion criteria, covering 14 intervention domains: alcohol; cancer; cannabis; communicable disease; cardiovascular disease; diabetes; diet; injury; mental illness; other non-communicable disease; overweight and obesity; physical inactivity; salt; tobacco. There were large variations in health gain across evaluations: 33.9% gained less than 0.1 HALYs per 1000 people in the total population over the remainder of their lifespan, through to 13.0% gaining >10 HALYs per 1000 people. Over a third (38.8%) of evaluations were cost-saving. Conclusions League tables of comparably conducted evaluations illustrate the large health gain (and cost) variations per capita between interventions, in addition to cost-effectiveness. Further work can test the utility of this league table with policy makers and researchers.

scholarly journals Exercise programmes to prevent falls among older adults: modelling health gain, cost-utility and equity impacts

2018 ◽  
Vol 25 (4) ◽  
pp. 258-263 ◽  
Author(s):  
Eamonn Deverall ◽  
Giorgi Kvizhinadze ◽  
Frank Pega ◽  
Tony Blakely ◽  
Nick Wilson
Keyword(s):  
Cost Effectiveness ◽  
Cochrane Review ◽  
Health Gain ◽  
Cost Effective ◽  
Exercise Programme ◽  
Falls Prevention ◽  
System Perspective ◽  
Home Based ◽  
Health Gains ◽  
Life Years

BackgroundSome falls prevention interventions for the older population appear cost-effective, but there is uncertainty about others. Therefore, we aimed to model three types of exercise programme each running for 25 years among 65+ year olds: (i) a peer-led group-based one; (ii) a home-based one and (iii) a commercial one.MethodsAn established Markov model for studying falls prevention in New Zealand (NZ) was adapted to estimate incremental cost-effectiveness ratios (ICERs) in cost per quality-adjusted life-years (QALYs) gained. Detailed NZ experimental, epidemiological and cost data were used for the base year 2011. A health system perspective was taken and a discount rate of 3% applied. Intervention effectiveness estimates came from a Cochrane Review.ResultsThe intervention generating the greatest health gain and costing the least was the home-based exercise programme intervention. Lifetime health gains were estimated at 47 100 QALYs (95%uncertainty interval (UI) 22 300 to 74 400). Cost-effectiveness was high (ICER: US$4640 per QALY gained; (95% UI US$996 to 10 500)), and probably more so than a home safety assessment and modification intervention using the same basic model (ICER: US$6060). The peer-led group-based exercise programme was estimated to generate 42 000 QALYs with an ICER of US$9490. The commercially provided group programme was more expensive and less cost-effective (ICER: US$34 500). Further analyses by sex, age group and ethnicity (Indigenous Māori and non-Māori) for the peer-led group-intervention showed similar health gains and cost-effectiveness.ConclusionsImplementing any of these three types of exercise programme for falls prevention in older people could produce considerable health gain, but with the home-based version being likely to be the most cost-effective.

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