The Effectiveness And Cost-Effectiveness Of Public Health Interventions To Prevent Falls In Children Under 5 Years

This work represents analyses undertaken as part of a National Institute for Health Research five-year multi-centre collaborative programme. The aim is to increase the evidence-base for interventions to prevent unintentional accidents in the home in children under-five. The focus is on the effectiveness and cost-effectiveness of interventions to increase the possession of fitted safety equipment or promote good safety practices to prevent falls. Pairwise meta-analyses, comparing the effectiveness of an enhanced intervention to usual care, informed a Cochrane Review update. Interventions are heterogeneous containing multiple components so network meta-analysis (NMA) was used to identify the most effective of seven interventions. The most intensive intervention was most effective with households more likely to possess a fitted safety gate than in the usual care group (OR=7.73(95%CrI: 4.14 to 14.4)). Individual participant data was incorporated to explore the effect of covariates, including child age and gender, and socioeconomic status but there was little evidence on any effect. The NMA results informed a cost-utility model to estimate the mean costs and quality adjusted life years (QALYS) associated with the interventions for increasing possession of a fitted stair safety gate. A simulated cohort of 100,000 UK households with a new-born were followed for the first three years, when there is highest risk of a fall, and then long-term. At a threshold value of £30,000 per QALY gained, none of the interventions were found to be cost-effective compared to usual care. Appraisals of public health interventions are rarely informed by analyses beyond a narrative review and/or pairwise meta-analysis, often because of the perceived lack of high quality evidence, heterogeneity in study designs, including interventions, outcome measures and scope, and a lack of expertise. This work has illustrated that more complex evidence synthesis can be used to provide more explicit, transparent and appropriate results to inform decision making.