Osteoporosis International

, Volume 26, Issue 4, pp 1367–1379 | Cite as

Cost-effectiveness of hip protector use on a geriatric ward in Germany: a Markov model

  • B. StollenwerkEmail author
  • T. Bartmus
  • F. Klug
  • S. Stock
  • D. Müller
Original Article



In this study, we determined the cost-effectiveness of hip protector use compared with no hip protector on a geriatric ward in Germany. From both the societal and the statutory health insurance (SHI) perspectives, the cost-effectiveness ratios for the provision of hip protectors were below €12,000/quality-adjusted life year (QALY) even if unrelated costs in added life years were included.


The aim of this study is to determine the cost-effectiveness of the provision of hip protectors compared with no hip protectors on a geriatric ward in Germany.


A lifetime decision-analytic Markov model was developed. Costs were measured from the societal and from the statutory health insurance (SHI) perspectives and comprised direct medical, non-medical and unrelated costs in additional life years gained. Health outcomes were measured in terms of quality-adjusted life years (QALYs). To reflect several levels of uncertainty, first- and second-order Monte Carlo simulation (MCS) approaches were applied.


Hip protector use compared with no hip protector results in savings (costs, −5.1/QALYs, 0.003) for the societal perspective. For the SHI perspective, the incremental cost-effectiveness ratio was €4416 €/QALY (costs, +13.4). If unrelated costs in life years gained were included, the cost-effectiveness ratio increases to €9794/QALY for the societal perspective and to €11,426/QALY for the SHI perspective. In the MCS, for the societal perspective without unrelated costs, 47 % of simulations indicated hip protectors to be cost saving (i.e. lower costs and higher effects).


Although the gain in QALYs due to the provision of providing hip protectors to patients on geriatric wards is small, all scenarios showed acceptable cost-effectiveness ratios or even savings.


Cost-effectiveness Hip fractures Hip protectors Markov model 


Conflicts of interest


Supplementary material

198_2014_3008_Fig3_ESM.gif (51 kb)
Figure A1

Scatterplots of incremental costs and effects (cost-effectiveness plain) for: societal perspective with unrelated medical costs (top left); societal perspective without unrelated medical costs (top right); statutory health insurance (SHI) perspective with unrelated medical costs (bottom left); SHI perspective without unrelated medical costs (bottom right). QALYs, quality-adjusted life years (GIF 50 kb)

198_2014_3008_MOESM1_ESM.tiff (7.3 mb)
High Resolution (TIFF 7500 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2015

Authors and Affiliations

  • B. Stollenwerk
    • 1
    Email author
  • T. Bartmus
    • 1
  • F. Klug
    • 1
  • S. Stock
    • 2
  • D. Müller
    • 2
  1. 1.Helmholtz Zentrum München, German Research Center for Environmental HealthInstitute of Health Economics and Health Care ManagementNeuherbergGermany
  2. 2.Institute of Health Economics and Clinical Epidemiology of the University of CologneCologneGermany

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