This study estimated the cost-effectiveness and budget impact of hip protectors for elderly living in Germany's nursing homes using societal and national health insurance viewpoints. The analysis compared clinical and economic outcomes of using hip protectors to no preventative measures. The findings indicate that, when compared with no intervention, wearing hip protectors led to cost-savings of €315 (C$507) and €257 (C$414) per person to society and the national health insurance, respectively. Moreover, wearing hip protectors was associated with a gain of 0.13 QALYS per person. This evidence supports policy suggestions made by the Canadian Agency for Drugs and Technologies in Health (CADTH) to introduce hip-protectors for fall prevention in elderly residents living in long-term care (LTC) facilities in Ontario.
: The wearing of hip protectors by elderly persons
living in long term care (LTC) facilities is not only cost saving
but also is associated with increased quality-adjusted life years
(QALYS). Hip fracture has an enormous economic impact and is one of
the most common causes of death in the elderly in Germany. In
Canada, mortality rate in the year following a hip fracture is
about 20%, with an estimated societal cost of C$34,000 per LTC
facility resident. However, hip fractures can be prevented with the
use of hip protectors - a device designed to protect the upper part
of the femur with shock-absorbing pads inserted on the each side.
This study evaluates the long-term costs and cost-effectiveness of
hip protector use in elderly living in Germany's nursing homes,
which is currently being considered for coverage under the German
statutory national health insurance. Methods: This
cost-effectiveness analysis study used societal and national health
insurance viewpoints, comparing clinical and economic outcomes of
using hip protectors to no prevention. The target population is
comprised of 81-year olds living in institutional settings. Costs
of implementation (adjusted for noncompliance), training,
treatment, rehabilitation, long term care, hospital infrastructure,
and nursing care were considered in the societal perspective. In
addition to the cost-effectiveness analyses, a budget impact
analysis from a national health insurance was also conducted to
determine the total annual economic impact of hip protector use. To
address uncertainty in the mean incremental cost-effectiveness
ratio, sensitivity analyses were conducted. The time horizon used
in this study was 17 years. Costs and outcome (quality-adjusted
life years gained) were obtained from published literature and were
discounted at the annual rate of 3 percent. All costs were
presented in 2004 euro and converted into Canadian dollars
Findings: Results from both the societal and the national
health insurance perspectives were consistent: wearing hip
protectors resulted in cost-savings of €315 (C$507) and
€257 (C$414) from societal and national health insurance
viewpoints, respectively, and a gain of 0.13 QALYs per person. The
budget impact analysis showed annual savings of approximately
€12.9 million (C$20.64 million) in Germany. Results from the
sensitivity analyses revealed that the cost-effectiveness ratio was
most sensitive to relative risk of fracture with hip protector.
Moreover, hip protector use leads to cost-saving unless protector
effectiveness is extremely low, or mortality rate at six months
after fracture is extremely high. Using cost-effectiveness
acceptability curve, as a method for summarizing information on
uncertainty in cost-effectiveness, demonstrates that the
probability of using hip protectors is cost-effective as compared
with status quo although a willingness to pay is zero. At a
willingness to pay of €3,680 per QALY, hip protectors have a
100% probability of being costeffective.
Conclusions: The use of hip protectors is a cost saving
option for reducing the risk of hip fracture in Germany's nursing
homes. Findings from this study appear to resonate with results
from the recent systematic review conducted by CADTH, which
reported that hip protector use was a cost-effective option for
women over 70 years of age, when compared with no intervention.
This study provides additional economic evidence that appears to be
sufficiently favourable to warrant consideration in providing hip
protectors for elderly residents living in LTC facilities in
Gandjour A, Weyler EJ. Cost-Effectiveness of Preventing Hip Fractures by Hip Protectors in Elderly Institutionalized Residents in Germany. Value in Health 2008; 11 (7): 1088 - 1095.
Brown A, Coyle D, Cimon K, Farrah K. Hip Protectors in Long-Term Care: A Clinical and Cost-Effectiveness Review and Primary Economic Evaluation. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2008.
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