Cost-benefit analysis of fall injuries prevented by a programme of home modifications: a cluster randomised controlled trial
Cost-benefit analysis of fall injuries prevented by a programme of home modifications: a cluster randomised controlled trial
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DOI：
10.1136/injuryprev-2015-041947
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发表时间：
2017-02-01
影响因子：
3.7
通讯作者：
Baker, Michael G.
中科院分区：
文献类型：
--
作者：
Keall, Michael D.;Pierse, Nevil;Baker, Michael G.
背景技术 在家中跌倒造成的伤害给社会带来了巨大的社会和经济成本。我们之前发现房屋改造具有重要的安全优势，例如台阶和楼梯的扶手、浴室的扶手、室外照明、室外台阶的边缘以及甲板等室外区域的防滑表面。在这里，我们评估了这些修改的经济效益。方法使用单盲整群随机对照试验，我们分析了国家伤害保险公司记录的治疗家庭坠落伤害的保险付款。将避免的伤残调整生命年 (DALY) 价值和节省的伤害社会成本方面的效益外推到国家水平，并与干预成本进行比较。 结果 进行了意向治疗分析。与未改造的房屋相比，每次暴露于改装房屋的伤害成本显示，房屋坠落伤害的成本降低了 33%（95% CI 5% 至 49%）。据估计，预防伤害的社会效益至少是干预成本的六倍。对于老年人来说，效益成本比至少可以增加一倍，对于有跌倒受伤史的人来说，效益成本比可以增加 60%。 结论 这是第一个随机对照试验，旨在检验家庭改造对降低普通人群跌倒伤害成本的好处。结果表明，进行相对低成本的房屋维修和安装安全装置以防止跌倒具有令人信服的经济理由。
Background Injuries due to falls in the home impose a huge social and economic cost on society. We have previously found important safety benefits of home modifications such as handrails for steps and stairs, grab rails for bathrooms, outside lighting, edging for outside steps and slip-resistant surfacing for outside areas such as decks. Here we assess the economic benefits of these modifications.Methods Using a single-blinded cluster randomised controlled trial, we analysed insurance payments for medically treated home fall injuries as recorded by the national injury insurer. The benefits in terms of the value of disability adjusted life years (DALYs) averted and social costs of injuries saved were extrapolated to a national level and compared with the costs of the intervention.Results An intention-to-treat analysis was carried out. Injury costs per time exposed to the modified homes compared with the unmodified homes showed a reduction in the costs of home fall injuries of 33% (95% CI 5% to 49%). The social benefits of injuries prevented were estimated to be at least six times the costs of the intervention. The benefit-cost ratio can be at least doubled for older people and increased by 60% for those with a prior history of fall injuries.Conclusions This is the first randomised controlled trial to examine the benefits of home modification for reducing fall injury costs in the general population. The results show a convincing economic justification for undertaking relatively low-cost home repairs and installing safety features to prevent falls.