Cost-effectiveness of an integrated falls prevention programme in primary healthcare for older people in rural China: an economic evaluation alongside the FAMILY trial.

BACKGROUND: Falls and fall-related injuries are the leading cause of morbidity and mortality for older adults. For China's rapidly ageing population, the need for cost-effective falls prevention programmes is critical. FAMILY, a 12-month cluster randomised controlled trial in rural China (2610 community-dwelling older adults), demonstrated that a primary healthcare-integrated balance and functional exercise fall prevention programme reduced falls. This study assessed its cost-effectiveness. METHODS: A within-trial economic evaluation was conducted from a healthcare system perspective. Incremental cost and effectiveness (falls prevented and quality-adjusted life-years [QALYs]) were estimated using mixed-effects regression models accounting for clustering. Costs included healthcare resource use and intervention delivery. QALYs were derived from EuroQol 5-Dimension 5-level (EQ-5D-5L) instrument administered during the trial. Uncertainty was assessed using one-way and probabilistic sensitivity analyses with two-stage bootstrapping. RESULTS: During a mean follow-up of 358 days, the intervention was dominant, with lower costs and greater effectiveness. The intervention reduced the absolute risk of falls by 8.6% and increased QALYs by 0.024 per person. Mean cost savings of ¥293 (95% CI: -¥145 to ¥727) were observed in the intervention group. This difference was mainly driven by lower healthcare utilisation costs (¥1517 vs ¥1831), which more than offset the intervention cost of ¥20 per participant. The probability of the intervention being cost-saving was 90%, and the probability of being cost-effective was 96%. CONCLUSIONS: A primary healthcare-integrated, falls prevention programme in rural China can improve health outcomes in older adults whilst reducing costs, providing a scalable solution for resource-constrained settings.