Cost-effectiveness analysis of multiple fall prevention interventions for older adults in China: A Markov model approach

We evaluated the long-term health outcomes and economic value of multiple fall prevention strategies for older adults in China to inform community-based resource allocation. From a societal perspective, a Markov model was used to compare Tai Chi, age-friendly home modifications, fall prevention education, and no intervention in 100,000 adults aged 60 years at baseline, over 25 annual cycles. The parameters were obtained from the published literature, national statistics, and market-based cost estimates. The costs and quality-adjusted life-years (QALYs) were discounted by 4.5% annually. The outcomes included total costs, QALYs, cost-utility ratios (CURs), incremental CURs (ICURs), net monetary benefits (NMB), and incremental NMBs (INMBs). The primary willingness-to-pay (WTP) threshold was set at twice the 2024 per capita gross domestic product of China. Scenario and sensitivity analyses were performed to assess uncertainty, and model validation checks were conducted. In the base-case analysis, age-friendly home modifications had the lowest total cost (19.203 billion Chinese Yuan (CNY)) and generated 1,154,412.72 QALYs. Tai Chi generated slightly more QALYs (1,154,571.13) but at a higher cost (19.650 billion CNY). Compared with age-friendly home modifications, both fall prevention education, and no intervention generated fewer QALYs and incurred higher costs. Incremental analysis revealed that Tai Chi was non-dominated but associated with a high ICUR compared with age-friendly home modifications, whereas fall prevention education and no intervention were strictly dominated. Age-friendly home modifications achieved the highest NMB and the highest probability of cost-effectiveness in the probabilistic sensitivity analysis (PSA). Fall prevention interventions for older adults in China may provide favorable economic value under the current model assumptions. Age-friendly home modifications demonstrated the most favorable economic profile, whereas Tai Chi may provide additional health gains at a substantially higher incremental cost; further real-world evidence is needed to validate these findings and support implementation decisions.