Skip to main content
SpringerLink
Log in

Cost-effectiveness of a multifactorial fall prevention program in nursing homes

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

The purpose of this study was to analyze the cost-effectiveness of a multifactorial fall prevention program in nursing home residents. Given a willingness-to-pay (WTP) of 50,000 EUR per year free of femoral fracture, the probability that the intervention is cost-effective is 83 %.

Introduction

Despite their increased risk of falls and fractures, nursing home residents have been neglected in economic evaluations of fall prevention programs so far. The purpose of this study was to analyze, for the first time, the cost-effectiveness of a multifactorial fall prevention program in nursing home residents.

Methods

This study is part of a prospective, unblinded, cluster, nonrandomized, controlled study focusing on the transfer of an efficacious fall prevention program into a real-world setting. The analyzed subsample was derived from claims data and consisted of data on intervention (n = 256, residents n = 10,178) and control homes (n = 893, residents n = 22,974), representing all insurants of a sickness fund (AOK Bavaria, Germany) who were 65 years or older, residing in a nursing home on the 31st of March 2007 and had a level of care of ≥1 according to the classification of the statutory long-term care insurance. Time free of femoral fracture (ICD-10, S72) was used as measure of health effects. Femoral fracture-related costs and intervention costs were measured from a payer perspective. Multivariate regression models were applied. Sensitivity analyses were performed and cost-effectiveness acceptability curves computed.

Results

Within the first year of the intervention, femoral fracture rate was significantly reduced, resulting in a nonsignificant incremental mean time of 1.41 days free of femoral fracture. Incremental mean total direct costs were 29 EUR per resident, which was not significant. The incremental cost-effectiveness ratio (ICER) was 7,481 EUR per year free of femoral fracture. The probability of an ICER < 50,000 EUR per year free of femoral fracture was 83 %.

Conclusion

Depending on the amount the decision-maker is willing to pay for the incremental effect, the fall prevention program might be cost-effective within the first year. Future studies should expand the range of costs and effects measured.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Peden M, McGee K, Krug EE. Injury: a leading cause of the global burden of disease, 2000. 2002. WHO.

  2. Peden M, McGee K, Sharma G. The injury chart book: a graphical overview of the global burden of injuries. 2002. WHO.

  3. WHO. The global burden of disease 2004 update. 2008.

  4. Watson W.L., Ozanne-Smith J. The cost of injury to Victoria. Monash University, Accident Research Center, report no. 124. 1997.

  5. Rice DP, MacKenzie EJ, Associates. Cost of injury in the United States: a report to Congress. 1989. San Francisco, CA.

  6. Corso P, Finkelstein E, Miller T, Fiebelkorn I, Zaloshnja E (2006) Incidence and lifetime costs of injuries in the United States. Inj Prev 12(4):212–8

    Article  PubMed  CAS  Google Scholar 

  7. Heinrich S, Rapp K, Rissmann U, Becker C, Konig HH (2010) Cost of falls in old age: a systematic review. Osteoporos Int 21(6):891–902

    Article  PubMed  CAS  Google Scholar 

  8. Borgstrom F, Kanis JA (2008) Health economics of osteoporosis. Best Pract Res Clin Endocrinol Metab 22(5):885–900

    Article  PubMed  Google Scholar 

  9. OECD Economics Department. Projecting OECD health and long-term care expenditures: what are the main drivers? Working paper no.477. 2006. OECD.

  10. Heinrich S, Luppa M, Matschinger H, Angermeyer MC, Riedel-Heller SG, Konig HH (2008) Service utilization and health-care costs in the advanced elderly. Value Health 11(4):611–20

    Article  PubMed  Google Scholar 

  11. Statistisches Bundesamt. Bevölkerung Deutschlands bis 2060. 12. koordinierte Bevölkerungsvorausberechnung. 2009. Wiesbaden, Statistisches Bundesamt.

  12. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev (2):CD007146.

  13. Corrieri S, Heider D, Riedel-Heller SG, Matschinger H, Konig HH (2011) Cost-effectiveness of fall prevention programs based on home visits for seniors aged over 65 years: a systematic review. Int Psychogeriatr :1-13.

  14. Cameron ID, Murray GRGLD, Robertson MC, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in nursing care facilities and hospitals. CD 005465. 2010. Cochrane Database of Systematic Reviews.

  15. Rapp K, Lamb SE, Erhardt-Beer L, Lindemann U, Rissmann U, Klenk J, Becker C (2010) Effect of a statewide fall prevention program on incidence of femoral fractures in residents of long-term care facilities. J Am Geriatr Soc 58(1):70–5

    Article  PubMed  Google Scholar 

  16. Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y (2002) Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial Ann Intern Med 136(10):733–41

    Google Scholar 

  17. McClure R, Turner C, Peel N, Spinks A, Eakin E, Hughes K (2005) Population-based interventions for the prevention of fall-related injuries in older people. Cochrane Database Syst Rev (1):CD004441.

  18. Tinetti ME, Baker DI, King M, Gottschalk M, Murphy TE, Acampora D, Carlin BP, Leo-Summers L, Allore HG (2008) Effect of dissemination of evidence in reducing injuries from falls. N Engl J Med 359(3):252–61

    Article  PubMed  CAS  Google Scholar 

  19. Becker C, Kron M, Lindemann U, Sturm E, Eichner B, Walter-Jung B, Nikolaus T (2003) Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc 51(3):306–13

    Article  PubMed  Google Scholar 

  20. Becker C, Cameron ID, Klenk J, Lindemann U, Heinrich S, Konig HH, Rapp K (2011) Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study. PLoS ONE 6(8):e24311

    Article  PubMed  CAS  Google Scholar 

  21. Bundesministerium für Gesundheit. Long-term care insurance. www.bmg.bund.de . 2010.

  22. Becker C, Lindemann U, Rißmann U, Warnke A (2006) Sturzprophylaxe: Sturzgefährdung und Sturzverhütung in Heimen (2., überarbeitete Auflage). Vincentz Network.

  23. DIMDI. ICD-10 2003: Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme. 2003. Köln.

  24. Heinrich S, Rapp K, Rissmann U, Becker C, Konig HH (2011) Service use and costs of incident femoral fractures in nursing home residents in Germany: the Bavarian Fall and Fracture Prevention Project (BF2P2). J Am Med Dir Assoc 12(6):459–66

    Article  PubMed  Google Scholar 

  25. Konnopka A, Jerusel N, Konig HH (2009) The health and economic consequences of osteopenia- and osteoporosis-attributable hip fractures in Germany: estimation for 2002 and projection until 2050. Osteoporos Int 20(7):1117–29

    Article  PubMed  CAS  Google Scholar 

  26. Heinrich S, Weigelt I, Rapp K, Becker C, Rissmann U, König HH (2012) Fall and fracture prevention based on the National Expert Standard: Implementation and costs in a real world setting in nursing homes. Z Gerontol Geriatr 45(2):128–137

    Article  PubMed  CAS  Google Scholar 

  27. Davison AC, Hinkley DV (1997) Bootstrap method and their application. University Press .

  28. Efron B, Tibshirani R (2010) Bootstrap methods for standard error, confidence intervals, and other measures of statistical accuracy. Statistical Sciences 1986:54–77

    Google Scholar 

  29. Johnson ML, Crown W, Martin BC, Dormuth CR, Siebert U (2009) Good research practices for comparative effectiveness research: analytic methods to improve causal inference from nonrandomized studies of treatment effects using secondary data sources: the ISPOR Good Research Practices for Retrospective Database Analysis Task Force report--part III. Value Health 12(8):1062–73

    Article  PubMed  Google Scholar 

  30. Hoch JS, Briggs AH, Willan AR (2002) Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ 11(5):415–30

    Article  PubMed  Google Scholar 

  31. Cusimano MD, Kwok J, Spadafora K (2008) Effectiveness of multifaceted fall-prevention programs for the elderly in residential care. Inj Prev 14(2):113–22

    Article  PubMed  CAS  Google Scholar 

  32. Meyer G, Wegscheider K, Kersten JF, Icks A, Muhlhauser I (2005) Increased use of hip protectors in nursing homes: economic analysis of a cluster randomized, controlled trial. J Am Geriatr Soc 53(12):2153–8

    Article  PubMed  Google Scholar 

  33. Thompson M, Pasquale M, Grima D, Moehrke W, Kruse HP (2010) The impact of fewer hip fractures with risedronate versus alendronate in the first year of treatment: modeled German cost-effectiveness analysis. Value Health 13(1):46–54

    Article  PubMed  Google Scholar 

  34. Brecht JG, Kruse HP, Mohrke W, Oestreich A, Huppertz E (2004) Health-economic comparison of three recommended drugs for the treatment of osteoporosis. Int J Clin Pharmacol Res 24(1):1–10

    PubMed  CAS  Google Scholar 

  35. Tidermark J, Zethraeus N, Svensson O, Tornkvist H, Ponzer S (2002) Femoral neck fractures in the elderly: functional outcome and quality of life according to EuroQol. Qual Life Res 11(5):473–81

    Article  PubMed  Google Scholar 

  36. Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, Jonsson B (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15(1):20–6

    Article  PubMed  CAS  Google Scholar 

  37. Lips P, van Schoor NM (2005) Quality of life in patients with osteoporosis. Osteoporos Int 16(5):447–55

    Article  PubMed  Google Scholar 

  38. Hirth RA, Chernew MEME, Fendrick AM, Weissert WG (2000) Willingness to pay for a quality-adjusted life year: in search of a standard. Medical Decision Making 20:332–42

    Article  PubMed  CAS  Google Scholar 

  39. Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA (2010) Does a home-based strength and balance programme in people aged > or =80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions. Br J Sports Med 44(2):80–9

    Article  PubMed  CAS  Google Scholar 

  40. Peeters GM, Heymans MW, de Vries OJ, Bouter LM, Lips P, van Tulder MW (2011) Multifactorial evaluation and treatment of persons with a high risk of recurrent falling was not cost-effective. Osteoporos Int 22(7):2187–96

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The usual disclaimer applies. We thank Ralf Brum, Regina Merk-Bäuml, Johannes Laws-Hofmann, Otto Gieseke, Stefanie Dörfler, Michaela Heil, Markus Gindl, and Gerhard Dahlhoff from the AOK for granting access to the data and support of our analyses.

Funding

KR is supported by a grant of the Forschungskolleg Geriatrie of the Robert Bosch Foundation, Stuttgart, Germany. The evaluation of the study was funded by the Bundesministerium für Bildung und Forschung (Förderkennzeichen: 01EL0702, 01EL0717, and 01EL0718). The AOK funded the implementation of The Bavarian Fall and Fracture Prevention Study. The AOK had no influence on the intervention components but participated in the implementation process. The evaluation of the intervention was not funded and not influenced by the AOK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

The AOK funded the implementation of The Bavarian Fall and Fracture Prevention Study. The first author is currently employed at the Federal Ministry of Health in Germany. The study and the manuscript were finished before this employment.

Author information

Authors and Affiliations

  1. Department of Medical Sociology and Health Economics, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    S. Heinrich, N. Stuhldreher & H.-H. König

  2. Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany

    K. Rapp, U. Rissmann & C. Becker

  3. Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany

    K. Rapp

Authors
  1. S. Heinrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Rapp
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Stuhldreher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U. Rissmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H.-H. König
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Heinrich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heinrich, S., Rapp, K., Stuhldreher, N. et al. Cost-effectiveness of a multifactorial fall prevention program in nursing homes. Osteoporos Int 24, 1215–1223 (2013). https://doi.org/10.1007/s00198-012-2075-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-012-2075-x

Keywords

Search

Navigation