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.

Background: 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$34,000 per LTC facility resident. However, hip fractures can be prevented with the use of hip protectors - a device designed to protect the upper part of the femur with shock-absorbing pads inserted on the each side. This study evaluates the long-term costs and cost-effectiveness of hip protector use in elderly living in Germany's nursing homes, which is currently being considered for coverage under the German statutory national health insurance. Methods: This cost-effectiveness analysis study used societal and national health insurance viewpoints, comparing clinical and economic outcomes of using hip protectors to no prevention. The target population is comprised of 81-year olds living in institutional settings. Costs of implementation (adjusted for noncompliance), training, treatment, rehabilitation, long term care, hospital infrastructure, and nursing care were considered in the societal perspective. In addition to the cost-effectiveness analyses, a budget impact analysis from a national health insurance was also conducted to determine the total annual economic impact of hip protector use. To address uncertainty in the mean incremental cost-effectiveness ratio, sensitivity analyses were conducted. The time horizon used in this study was 17 years. Costs and outcome (quality-adjusted life years gained) were obtained from published literature and were discounted at the annual rate of 3 percent. All costs were presented in 2004 euro and converted into Canadian dollars (€1=$C1.60).

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 Ontario.

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