Health Economics Scenario Lab
SafeStep
Explore how falls prevention might reduce falls, admissions, bed use, and economic burden under different assumptions.
Scope and use note
SafeStep is an exploratory scenario sandbox. It is designed to test how changes in risk, effect, uptake, persistence, and delivery cost might influence potential clinical and economic value. It does not replace formal evaluation, forecasting, or business case development.
Signal
Appears high-cost for value gained
Net cost
£1,155,853
Cost/QALY
£129,176
Headline view
Start with the current decision signal and the main economic outputs.
Falls avoided
184
Admissions avoided
37
Net cost
£1,155,853
Discounted cost per QALY
£129,176
Return on spend
0.10x
Break-even cost per participant
£59
Required intervention effect
67%
Current case type
Broad prevention case
What this suggests
The model suggests that the intervention may reduce falls and admissions, but the economic return is weak under the current assumptions.
Main dependency
The result is currently most influenced by relative risk reduction.
Main fragility
The case remains above threshold across the bounded range, so the current value proposition looks weak under these assumptions.
Charts
Primary chart first, with supporting views below.
Cost vs savings
Cumulative delivery cost against gross savings.
Assumptions
Start from the default case, then adjust the key inputs and advanced settings.
Quick assumptions
Core setup
Core fall burden assumption.
Core avoided-falls assumption.
Targeting approach
These three multipliers replace fixed targeting modes and let you control how concentrated the opportunity is.
Analysis
Review the current case, uncertainty, sensitivity, and practical next checks.
Report export
Export a structured summary of the current assumptions, results, and interpretation.
Strategic summary
SafeStep currently indicates clinical value, but limited economic attractiveness.
Net cost of £1,155,853 and discounted cost per QALY of £129,176.
Bed days avoided
258
QALYs gained
8.95
Programme cost
£1,281,123
Recommendation summary
What this suggests
The current case suggests clinical benefit, but the economic case is not yet persuasive at the current threshold.
What is driving it
The result is currently most influenced by relative risk reduction.
What looks fragile
The case remains above threshold across the bounded range, so the current value proposition looks weak under these assumptions.
Validate next
Validate local estimates for relative risk reduction and annual fall risk before treating this case as decision-ready.
Uncertainty readout
Low
£224,415
131 falls avoided · Above current threshold
Base
£129,176
184 falls avoided · Above current threshold
High
£72,850
246 falls avoided · Above current threshold
Top sensitivity drivers
Driver 1
Relative risk reduction
Largest ICER swing: £35,794
Driver 2
Annual fall risk
Largest ICER swing: £35,794
Driver 3
Target fall-risk multiplier
Largest ICER swing: £35,794
Confidence summary
3 high-confidence, 14 medium-confidence, and 3 low-confidence assumptions are currently in play.
Headline view
Start with the current decision signal and the main economic outputs.
Falls avoided
184
Admissions avoided
37
Net cost
£1,155,853
Discounted cost per QALY
£129,176
Bed days avoided
258
Programme cost
£1,281,123
Gross savings
£125,270
QALYs gained
8.95
Return on spend
0.10x
Break-even cost per participant
£59
Required intervention effect
67%
Current case type
Broad prevention case
What this suggests
The model suggests that the intervention may reduce falls and admissions, but the economic return is weak under the current assumptions.
Main dependency
The result is currently most influenced by relative risk reduction.
Main fragility
The case remains above threshold across the bounded range, so the current value proposition looks weak under these assumptions.
Charts
Primary chart first, with supporting views below.
Cost vs savings
Cumulative delivery cost against gross savings.
Clinical impact
Headline avoided-activity impact over the selected horizon.
Falls avoided
Annual impact across the selected horizon.
Bounded uncertainty
Low, base, and high cases against the current threshold.
One-way sensitivity
Top drivers of discounted cost per QALY when varied one at a time.
Assumptions
Start from the default case, then adjust the key inputs and advanced settings.
Quick assumptions
Core setup
Core fall burden assumption.
Core avoided-falls assumption.
Targeting approach
These three multipliers replace fixed targeting modes and let you control how concentrated the opportunity is.
Advanced assumptions
Analysis
Review the current case, uncertainty, sensitivity, and validation prompts.
Report export
Export a structured summary of the current assumptions, results, and interpretation.
Strategic summary
SafeStep currently indicates clinical value, but limited economic attractiveness.
Net cost of £1,155,853 and discounted cost per QALY of £129,176.
Bed days avoided
258
QALYs gained
8.95
Programme cost
£1,281,123
Recommendation summary
What this suggests
The current case suggests clinical benefit, but the economic case is not yet persuasive at the current threshold.
What is driving it
The result is currently most influenced by relative risk reduction.
What looks fragile
The case remains above threshold across the bounded range, so the current value proposition looks weak under these assumptions.
Validate next
Validate local estimates for relative risk reduction and annual fall risk before treating this case as decision-ready.
Uncertainty readout
Low
£224,415
131 falls avoided · Above current threshold
Base
£129,176
184 falls avoided · Above current threshold
High
£72,850
246 falls avoided · Above current threshold
Sensitivity
One-way sensitivity
Top drivers of discounted cost per QALY when varied one at a time.
Driver 1
Relative risk reduction
Largest ICER swing: £35,794
Driver 2
Annual fall risk
Largest ICER swing: £35,794
Driver 3
Target fall-risk multiplier
Largest ICER swing: £35,794
Decision readout
Current case type
Broad prevention case
Uncertainty readout
Not robust across bounded range
Interpretation summary
The model suggests that the intervention may reduce falls and admissions, but the economic return is weak under the current assumptions.
Confidence summary
3 high-confidence, 14 medium-confidence, and 3 low-confidence assumptions are currently in play.
Assumption review
Eligible population
5,000
Operational estimate · Medium confidence
Programme uptake
50%
Operational estimate · Medium confidence
Programme completion
75%
Operational estimate · Medium confidence
Annual participation drop-off
6%
Illustrative default · Low confidence
Target population multiplier
1.00
User override · Medium confidence
Target uptake multiplier
1.00
User override · Medium confidence
Target fall-risk multiplier
1.00
User override · Medium confidence
Annual fall risk
24%
Evidence-informed proxy · Medium confidence
Falls leading to admission
20%
Evidence-informed proxy · Medium confidence
Average length of stay
7.0
Operational estimate · Medium confidence
Cost per participant
£250
Operational estimate · Medium confidence
Reduction in falls
16%
Evidence-informed proxy · Medium confidence
Annual effect decay
10%
Illustrative default · Low confidence
Costing method
Admission cost only
User override · Medium confidence
Cost per admission
£3,500
Operational estimate · Medium confidence
Cost per bed day
£400
Illustrative default · Low confidence
QALY loss per serious fall
0.05
Evidence-informed proxy · Medium confidence
Cost-effectiveness threshold
£20,000
Illustrative default · High confidence
Time horizon
3
User override · High confidence
Discount rate
4%
Evidence-informed proxy · High confidence