Cost-Effectiveness of Hip Protectors in the Prevention of Osteoporosis Related Hip Fractures in Elderly Nursing Home Residents

SONIA SINGH, HUIYING SUN, and ASLAM H. ANIS

ABSTRACT.

Objective. Hip fracture is a common complication of osteoporosis, resulting in significant morbidity and mortality, with a high financial cost to the healthcare system. Hip protectors have been advocated as an effective method to prevent hip fractures in high-risk individuals. This study models the cost-effectiveness of hip protectors in the prevention of osteoporosis related hip fractures in elderly nursing home residents.

Methods. An incremental cost-effectiveness analysis was performed comparing hip protectors to "no treatment" and to "calcium and vitamin D supplements." The study population was a hypothetical cohort of 1000 nursing home residents. A societal perspective, with a lifetime time horizon, was adopted. Data regarding costs, effectiveness, and quality of life measures were collected from the current literature and from Peace Arch Hospital, a community hospital in White Rock, British Columbia, Canada. Sensitivity analysis was performed.

Results. Hip protector use was found to be a dominant strategy compared to no treatment and to calcium and vitamin D supplements. Dominance implies lower cost and higher effect, generating cost-effectiveness ratios less than zero. Dominance with respect to cost and effectiveness of hip protectors in preventing hip fractures persisted when the model was subjected to probabilistic sensitivity analysis.

Conclusion. Cost-effectiveness analysis suggests that hip protectors could save money while preventing hip fractures and improving quality of life in nursing home residents. (J Rheumatol 2004;31:1607-13)

Key Indexing Terms:

COST-EFFECTIVENESS
OSTEOPOROSIS
HIP PROTECTOR
HIP FRACTURE

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From the Department of Healthcare and Epidemiology, University of British Columbia, Vancouver; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Providence Healthcare, Vancouver; and Peace Arch Hospital, White Rock, British Columbia, Canada.

S. Singh, MD, MHSc, Department of Healthcare and Epidemiology, University of British Columbia and Peace Arch Hospital; H. Sun, PhD, Department of Healthcare and Epidemiology, University of British Columbia; A.H. Anis, PhD, Department of Healthcare and Epidemiology, University of British Columbia and St Paul's Hospital, Providence Healthcare.

Address reprint requests to Dr. A.H. Anis, CHEOS, St. Paul's Hospital, 620-1801 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. E-mail: aslam.anis@ubc.ca

Submitted July 11, 2003; revision accepted February 17, 2004.

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