Falls programme saves costs in rural China

A village doctor-led exercise programme reduced falls and was likely cost-saving.
*Economic evaluation alongside cluster randomized trial; Level 2 (OCEBM).

Citation

Wei T, Peng J, Ye P, et al. Cost-effectiveness of an integrated falls prevention programme in primary healthcare for older people in rural China: an economic evaluation alongside the FAMILY trial. Age and Ageing. 2026;55:afag282. doi:10.1093/ageing/afag282

Background

Falls are a major cause of injury and death in older adults, especially where health resources are limited. This study tested whether adding structured balance and functional exercises to rural primary care in China was good value for money.

Patients

2606 community-dwelling adults aged 60 years or older in 128 rural Chinese villages, with prior falls or fear of falling, able to walk independently. Exclusions included inability to participate in regular exercise, relocation, or loss of contact.

Intervention

Village doctor-led group exercise at least monthly, home exercise at least four times weekly, videos, and quarterly fall-prevention education.

Control

Usual quarterly oral health education through existing public health services.

Outcome

Falls, fall-related costs, and quality-adjusted life-years from the EuroQol 5-Dimension 5-Level questionnaire (5 domains, each level 1 to 5).

Follow-up Period

Mean 358 days.

Results

Outcome Intervention vs control Effect
At least one fall 29.7% vs 38.3% OR 0.67 (95% CI 0.48 to 0.91); absolute reduction 8.6% (95% CI 1.7% to 16.0%); NNT 12
Falls per person-year 0.8 vs 1.4 RR 0.66 (95% CI 0.46 to 0.94)
Other fall-injury costs ¥226 vs ¥318 Mean difference −¥92 (95% CI −¥171.3 to −¥18.7)

OR: odds ratio; RR: risk ratio; CI: confidence interval; NNT: number needed to treat.

The programme cost ¥20 per participant. Total cost savings and quality-adjusted life-year gains favored intervention but were not statistically significant. Probability of being cost-saving was 90%; cost-effective, 96%. Analysis was modified intention-to-treat. The control was current usual care.

Limitations

Healthcare costs for fall injuries were estimated from published data rather than each participant’s actual treatment records. Follow-up lasted only one year. The study tested a bundled programme, so the separate value of exercise versus education is unknown. Results may not generalize beyond similar rural systems.

Funding

Chinese public/university grants and Australian scholarship; funders had no reported role.

Clinical Application

Consider integrating low-cost, supervised balance exercises into rural primary care for older adults at increased fall risk.