Increased use of hip protectors in nursing homes: economic analysis of a cluster randomized, controlled trial

Abstract

Objectives: To assess the cost-efficacy of an intervention program aimed at reducing hip fractures.

Design: Economic evaluation within an 18-month cluster randomized trial.

Setting: Forty-nine nursing homes in Hamburg, Germany.

Participants: Residents with a high risk of falling (intervention group (IG), n=459; control group (CG), n=483).

Intervention: Education session for nurses, who subsequently educated residents, and provision of three hip protectors per resident. CG care was optimized by providing brief information to nurses about hip protectors and providing two protectors per nursing home for demonstration purposes.

Measurements: Main outcomes were hip fractures, costs, and incremental cost-effectiveness ratio (ICER).

Results: The intervention was effective in reducing hip fractures (21 in the IG vs 42 in the CG) and resulted in a cost difference of 51 dollars per participant in favor of the CG (95% confidence interval covering cost saving of 242 dollars to cost expense of 325 dollars). Costs per additional hip fracture avoided were 1,234 dollars. Sensitivity analyses aimed at investigating robustness of the results to a real practice implementation scenario resulted in ICERs varying from 439 dollars to 1,693 dollars. Taking into account lower hip protector reimbursement levels, the intervention program would be cost saving (break-even point within the base case analysis=22 dollars per hip protector).

Conclusion: A program consisting of education and provision of hip protectors might produce a slight increase in costs or might even be cost saving if the price of the hip protector could be decreased.