OBJECTIVES: To compare and contrast the cost-effectiveness of multimodal versus unimodal interventions that include exercise to prevent falls among community dwelling older adults.

METHODS: : We conducted a systematic review of peer reviewed manuscripts reporting an economic evaluation of multimodal and/or unimodal intervention that included exercise to prevent falls among community dwelling older adults aged 60 years and older. We searched MEDLINE, EMBASE, NHS EED, and CINAHL databases to identify cost-effectiveness studies from 1946 through July 2021. Data were extracted on type of economic evaluation, intervention, and comparator (i.e., control), mean costs and health effects, incremental cost-effectiveness and cost-utility ratios, and type of sensitivity analysis. The primary outcome measure of our analysis was incremental cost-effectiveness, cost utility, and cost-benefit ratios in the reported currency and in US dollars at July 2021 prices to provide a basis for comparison. Study reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

RESULTS: : Nineteen studies were included in this systematic review: 15 unimodal and 10 multimodal fall prevention intervention. Three studies reported both multimodal and unimodal components. Multimodal interventions included exercise in addition to medical assessment and referrals, medication adjustment or other interventions for falls. Unimodal intervention included group-based (n=9) or home-based (n=4) exercise programs. For multimodal interventions, 5 were cost-effectiveness analyses (CEAs), 2 were cost-utility analyses (CUAs), 2 included both and 1 was a cost-benefit analysis (CBA). For unimodal interventions, 4 were CEAs, 1 was a CUA and 5 included both. For CEAs, 286% (n=2/7) of multimodal interventions compared with 61.5% (n=8/13) of unimodal interventions demonstrated cost-effectiveness. For CUAs, no multimodal intervention (n=0/4) compared with 60% (n=6/10) of unimodal interventions reported cost-effectiveness.

CONCLUSIONS: : Unimodal interventions demonstrated greater cost-effectiveness than multi-modal interventions. Cost-effectiveness was most frequently reported for group-based unimodal interventions although this varied based on the cost-effectiveness threshold used.