The cost-effectiveness of multi-component interventions to prevent delirium in older people undergoing surgical repair of hip fracture

  • Anayo Akunne
  • Sarah Davis
  • Maggie Westby
  • John Young
Original Article


This article summarizes the detailed cost-effectiveness analysis of delirium prevention interventions in people undergoing surgical repair of hip fracture. We compared a multi-component delirium prevention intervention with usual care using a model based on a decision tree analysis. The model was used to estimate the incremental net monetary benefit (INMB). The robustness of the cost-effectiveness result was explored using deterministic and probabilistic sensitivity analyses. The multi-component prevention intervention was cost-effective when compared to usual care. It was associated with an INMB of £8,180 using a cost-effectiveness threshold of £20,000 per QALY. It remained cost-effective in the majority of the deterministic sensitivity analyses and was cost-effective in 96.4 % of the simulations carried out in the probabilistic sensitivity analysis. We have demonstrated the cost-effectiveness of a multi-component delirium prevention intervention that targets modifiable risk factors for delirium in older people undergoing surgical repair of hip fracture. It is an attractive intervention for practitioners and health care policy makers as they address the double burden of hip fracture and delirium.


Delirium Prevention Cost-effectiveness Multi-component intervention 



The method and results presented here draw completely from the full version of the NICE clinical guideline 103: the diagnosis, prevention and management of delirium (see reference 1). The guideline was developed by the National Clinical Guideline Centre which is funded by NICE. The important input of the Guideline Development Group is gratefully acknowledged. In the guideline, NICE recommends that a tailored multi-component delirium prevention intervention, delivered by a multidisciplinary team, should be provided in hospitals and in long-term care for people at risk of delirium. The economic evidence presented here was used to support this recommendation. The authors of this article are employed by the organizations for which they have provided contact details. They did not receive additional funding for writing this article. The views expressed in this article are those of the authors and not necessarily those of NICE or the organizations they work for. Anayo Akunne and Sarah Davis were working at the National Clinical Guideline Centre at the time the guideline was developed. We are particularly grateful to Lakshmi Murthy, whose work on the review that underpins the model was important. At the time the guideline was developed, Lakshmi Murthy was a Research Fellow at the National Clinical Guideline Centre.

Conflict of interest

Dr A Akunne, Ms S Davis and Dr M Westby were employed at the National Clinical Guideline Centre when the economic model that underpins this manuscript was developed. The Guideline Centre was funded by the UK National Institute for Health and Clinical Excellence to develop the guideline from which this manuscript was drawn. Prof J Young was involved in a Programme Grant for Delirium Prevention. The awarding institution was the National Institute for Health Research, UK.


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Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • Anayo Akunne
    • 1
  • Sarah Davis
    • 2
  • Maggie Westby
    • 3
  • John Young
    • 4
  1. 1.KSG-Trans LtdHeadington, OxfordUK
  2. 2.School of Health and Related ResearchThe University of SheffieldSheffieldUK
  3. 3.National Clinical Guideline CentreRoyal College of PhysiciansLondonUK
  4. 4.Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health ResearchBradford Royal InfirmaryBradfordUK

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