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Could a policy of provision of hip protectors to elderly nursing home residents result in cost savings in acute hip fracture care? The case of Ontario, Canada

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Abstract

Summary

Hip fractures are an important problem in nursing homes. Hip protectors are external devices that decrease the risk of hip fracture in elderly nursing home residents. We estimated the overall healthcare cost savings from a hypothetical strategy of provision of hip protectors to elderly nursing home residents in Ontario, Canada. In a recent meta-analysis, we determined that a strategy of provision of hip protectors decreases the risk of hip fracture in nursing home residents.

Introduction

Our objective was to determine whether the provision of hip protectors to all Ontario nursing home residents aged ≥65 years could result in cost savings, stemming from reductions in initial hospitalizations for hip fracture.

Methods

We conducted a cost analysis from a Ministry of Health perspective (one year cycle length). The efficacy of the intervention was estimated from a meta-analysis of randomized controlled trials.

Results

A strategy of provision of hip protectors to all 60,775 elderly Ontario nursing home residents could result in an overall mean cost savings of 6.0 million Canadian dollars in one year (95% credibility interval, −26.4 million, 39.7 million), with a probability of cost savings of 0.63 (assuming no additional labor costs). In sensitivity analyses, decreasing hip protector price increased cost savings, whereas additional labor expenditures for application for hip protectors decreased cost savings.

Conclusion

In conclusion, if hip protectors can be provided to elderly Ontario nursing home residents without additional labor expenditures, there is a reasonable probability that such a strategy may result in healthcare cost savings.

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References

  1. Weller I, Schatzker J (2004) Hip fractures and Alzheimer’s disease in elderly institutionalized Canadians. Ann Epidemiol 14(5):319–324

    Article  PubMed  Google Scholar 

  2. Chandler JM, Zimmerman SI, Girman CJ, Martin AR, Hawkes W, Hebel JR, Sloane PD, Holder L, Magaziner J (2000) Low bone mineral density and risk of fracture in white female nursing home residents. J Am Med Assoc 284(8):972–977

    Article  CAS  Google Scholar 

  3. Singh S, Sun H, Anis AH (2004) Cost-effectiveness of hip protectors in the prevention of osteoporosis related hip fractures in elderly nursing home residents. J Rheumatol 31(8):1607–1613

    PubMed  Google Scholar 

  4. Lauritzen JB (1997) Hip fractures. Epidemiology, risk factors, falls, energy absorption, hip protectors, and prevention. Dan Med Bull 44(2):155–168

    PubMed  CAS  Google Scholar 

  5. Cumming RG (1996) Nursing home residence and risk of hip fracture. Am J Epidemiol 143(12):1191–1194

    PubMed  CAS  Google Scholar 

  6. Brennan nee SJ, Johansen A, Butler J, Stone M, Richmond P, Jones S, Lyons RA (2003) Place of residence and risk of fracture in older people: a population-based study of over 65-year-olds in Cardiff. Osteoporos Int 14(6):515–519

    Article  Google Scholar 

  7. Ooms ME, Vlasman P, Lips P, Nauta J, Bouter LM, Valkenburg HA (1994) The incidence of hip fractures in independent and institutionalized elderly people. Osteoporos Int 4(1):6–10

    Article  PubMed  CAS  Google Scholar 

  8. Norton R, Campbell AJ, Reid IR, Butler M, Currie R, Robinson E, Gray H (1999) Residential status and risk of hip fracture. Age Ageing 28(2):135–139

    Article  PubMed  CAS  Google Scholar 

  9. Butler M, Norton R, Lee-Joe T, Cheng A, Campbell AJ (1996) The risks of hip fracture in older people from private homes and institutions. Age Ageing 25(5):381–385

    Article  PubMed  CAS  Google Scholar 

  10. Vu MQ, Weintraub N, Rubenstein LZ (2004) Falls in the nursing home: are they preventable? J Am Med Dir Assoc 5(6):401–406

    Article  PubMed  Google Scholar 

  11. Zimmerman SI, Girman CJ, Buie VC, Chandler J, Hawkes W, Martin A, Holder L, Hebel JR, Sloane PD, Magaziner J (1999) The prevalence of osteoporosis in nursing home residents. Osteoporos Int 9(2):151–157

    Article  PubMed  CAS  Google Scholar 

  12. Komar L, Nieves J, Cosman F, Rubin A, Shen V, Lindsay R (1993) Calcium homeostasis of an elderly population upon admission to a nursing home. J Am Geriatr Soc 41(10):1057–1064

    PubMed  CAS  Google Scholar 

  13. Morris JC, Rubin EH, Morris EJ, Mandel SA (1987) Senile dementia of the Alzheimer’s type: an important risk factor for serious falls. J Gerontol 42(4):412–417

    PubMed  CAS  Google Scholar 

  14. Buchner DM, Larson EB (1987) Falls and fractures in patients with Alzheimer-type dementia. J Amer Med Assoc 257(11):1492–1495

    Article  CAS  Google Scholar 

  15. Johansson C, Skoog I (1996) A population-based study on the association between dementia and hip fractures in 85-year olds. Aging (Milano) 8(3):189–196

    CAS  Google Scholar 

  16. Melton LJ, III, Beard CM, Kokmen E, Atkinson EJ, O’Fallon WM (1994) Fracture risk in patients with Alzheimer’s disease. J Am Geriatr Soc 42(6):614–619

    PubMed  Google Scholar 

  17. Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E (2001) Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 12(4):271–278

    Article  PubMed  CAS  Google Scholar 

  18. Ontario Ministry of Health and Long-term Care (2004) Resident classification system. In: Ontario provincial report, 2004. Queen’s Park Printers, Toronto, Ontario, p.7

    Google Scholar 

  19. Parkkari J, Kannus P, Poutala J, Vuori I (1994) Force attenuation properties of various trochanteric padding materials under typical falling conditions of the elderly. J Bone Miner Res 9(9):1391–1396

    Article  PubMed  CAS  Google Scholar 

  20. Kannus P, Parkkari J, Poutala J (1999) Comparison of force attenuation properties of four different hip protectors under simulated falling conditions in the elderly: an in vitro biomechanical study. Bone 25(2):229–235

    Article  PubMed  CAS  Google Scholar 

  21. Robinovitch SN, Hayes WC, McMahon TA (1995) Energy-shunting hip padding system attenuates femoral impact force in a simulated fall. J Biomech Eng 117(4):409–413

    PubMed  CAS  Google Scholar 

  22. Sawka AM, Boulos P, Beattie K, Thabane L, Papaioannou A, Gafni A, Cranney A, Zytaruk N, Hanley DA, Adachi JD (2005) Do hip protectors decrease the risk of hip fracture in institutional and community dwelling elderly? A systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 16(12):1461–1474

    Article  PubMed  Google Scholar 

  23. Sawka AM, Boulos P, Beattie K, Papaioannou A, Gafni A, Cranney A, Hanley DA, Adachi JD, Papadimitropoulos EA, Thabane L (2006) Hip protectors decrease the risk of hip fracture in elderly nursing home residents: a Bayesian meta-analysis. In press, J Clin Epidemiol

  24. Molloy DW, Guyatt GH, Russo R, Goeree R, O’Brien BJ, Bedard M, Willan A, Watson J, Patterson C, Harrison C, Standish T, Strang D, Darzins PJ, Smith S, Dubois S (2000) Systematic implementation of an advance directive program in nursing homes: a randomized controlled trial. J Am Med Assoc 283(11):1437–1444

    Article  CAS  Google Scholar 

  25. Schroder HM, Erlandsen M (1993) Age and sex as determinants of mortality after hip fracture: 3,895 patients followed for 2.5–18.5 years. J Orthop Trauma 7(6):525–531

    Article  PubMed  CAS  Google Scholar 

  26. Ontario Ministry of Health and Long-term Care (2003) Schedule of benefits for physician services under the health insurance act. Electronic PDF file accessed at the website: http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn (Accessed on February 16, 2005)

  27. Parker MJ, Gillespie WJ, Gillespie LD, Gillespie WJ (2005) Hip protectors for preventing hip fractures in the elderly. Cochrane Database of Systematic Reviews 1

  28. Government of Ontario (2005) Ontario job futures: Find an occupation-3413 Nurses Aides, Orderlies, and Patient Service Associates. Website: http://www1.on.hrdc-drhc.gc.ca/ojf/ojf.jsp?lang=e&section=Profile&noc=3413. Accessed November 6, 2006

  29. MRC Biostatistics Unit (Cambridge University) (2006) The BUGS Project-Bayesian inference using Gibbs sampling. Website: http://www.mrc-bsu.cam.ac.uk/bugs/welcome.shtml (Accessed Feb 14, 2006)

  30. Utts JM (1999) Chapter 2. In: Utts JM (ed) Seeing through statistics. Brooks-Cole/Duxbury Press, Pacific Grove, CA, p 210

    Google Scholar 

  31. Sendi P, Gafni A, Birch S (2002) Opportunity costs and uncertainty in the economic evaluation of health care interventions. Health Econ 11(1):23–31

    Article  PubMed  CAS  Google Scholar 

  32. Waldegger L, Cranney A, Man-Son-Hing M, Coyle D (2003) Cost-effectiveness of hip protectors in institutional dwelling elderly. Osteoporos Int 14(3):243–250

    PubMed  Google Scholar 

  33. Fleurence RL (2004) Cost-effectiveness of fracture prevention treatments in the elderly. Int J Technol Assess 20(2):184–191

    Article  Google Scholar 

  34. Kumar BA, Parker MJ (2000) Are hip protectors cost effective? Injury 31(9):693–695

    Article  PubMed  CAS  Google Scholar 

  35. Segui-Gomez M, Keuffel E, Frick KD (2002) Cost and effectiveness of hip protectors among the elderly. Int J Technol Assess 18(1):55–66

    Google Scholar 

  36. Colon-Emeric CS, Datta SK, Matchar DB (2003) An economic analysis of external hip protector use in ambulatory nursing facility residents. Age Ageing 32(1):47–52

    Article  PubMed  Google Scholar 

  37. van Schoor NM, de Bruyne MC, van der RN, Lommerse E, van Tulder MW, Bouter LM, Lips P (2004) Cost-effectiveness of hip protectors in frail institutionalized elderly. Osteoporos Int 15(12):964–969

    Article  PubMed  Google Scholar 

  38. Honkanen LA, Schackman BR, Mushlin AI, Lachs MS (2005) A cost-benefit analysis of external hip protectors in the nursing home setting. J Am Geriatr Soc 53(2):190–197

    Article  PubMed  Google Scholar 

  39. 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):2153–2158

    Article  PubMed  Google Scholar 

  40. van Schoor NM, Smit JH, Twisk JW, Bouter LM, Lips P (2003) Prevention of hip fractures by external hip protectors: a randomized controlled trial. J Am Med Assoc 289(15):1957–1962

    Article  Google Scholar 

  41. Papaioannou A, Wiktorowicz M, Adachi JD, Goeree R, Papadimitropoulos E, Bedard M, Brazil K, Parkinson W, Weaver B (2000) Mortality, independence in living, and refracture, one year following hip fracture in Canadians. J Soc Obstet Gynaecol Can 22(8):591–597

    Google Scholar 

  42. van Schoor NM, Deville WL, Bouter LM, Lips P (2002) Acceptance and compliance with external hip protectors: a systematic review of the literature. Osteoporos Int 13:917–924

    Article  PubMed  Google Scholar 

  43. Forsen L, Arstad C, Sandvig S, Schuller A, Roed U, Sogaard AJ (2003) Prevention of hip fracture by external hip protectors: An intervention in 17 nursing homes in two municipalities in Norway. Scand J Public Health 31:261–266

    Article  PubMed  Google Scholar 

  44. Thompson P, Jones C, Dawson A, Thomas P, Villar T (2005) An in-service evaluation of hip protector use in residential homes. Age and Ageing 34:52–56

    Article  PubMed  Google Scholar 

  45. Burl J, Centola J, Bonner A, Burque C (2003) Hip protector compliance: A 13-month study on factors and cost in a long-term care facility. J Am Med Dir Assoc 4:245–250

    Article  PubMed  Google Scholar 

  46. Kanis JA, Jonsson B (2002) Economic evaluation of interventions for osteoporosis. Osteoporos Int 13(10):765–767

    Article  PubMed  CAS  Google Scholar 

  47. Birch S, Gafni A (2004) The ’NICE’ approach to technology assessment: an economics perspective. Health Care Manag Sci 7(1):35–41

    Article  PubMed  Google Scholar 

  48. Birch S, Gafni A (2003) Economics and the evaluation of health care programmes: generalisability of methods and implications for generalisability of results. Health Policy 64(2):207–219

    Article  PubMed  Google Scholar 

  49. Birch S, Gafni A (1992) Cost effectiveness/utility analyses. Do current decision rules lead us to where we want to be? J Health Econ 11(3):279–296

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

A.M. Sawka is supported in part by a Canadian Institutes of Health Research New Investigator Award. No project funding was received for this study.

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Authors and Affiliations

  1. Division of Endocrinology and Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada

    A. M. Sawka

  2. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    A. Gafni & L. Thabane

  3. Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada

    A. Gafni

  4. Division of Rheumatology and Department of Medicine, St. Joseph’s Healthcare and McMaster University, Hamilton, ON, Canada

    P. Boulos, K. Beattie & J. D. Adachi

  5. Division of Geriatrics and Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada

    A. Papaioannou

  6. Division of Rheumatology and Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    A. Cranney

  7. Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    D. A. Hanley

  8. Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada

    A. Cheung

  9. Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

    E. A. Papadimitropoulos

  10. Eli Lilly Canada, Toronto, ON, Canada

    E. A. Papadimitropoulos

  11. Centre for Evaluation of Medicines, St. Joseph’s Healthcare, Hamilton, ON, Canada

    L. Thabane

  12. Toronto General Hospital, 200 Elizabeth Street, Eaton North 12-212, Toronto, ON, M5G 2C4, Canada

    A. M. Sawka

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  1. A. M. Sawka
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  8. J. D. Adachi
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Correspondence to A. M. Sawka.

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Sawka, A.M., Gafni, A., Boulos, P. et al. Could a policy of provision of hip protectors to elderly nursing home residents result in cost savings in acute hip fracture care? The case of Ontario, Canada. Osteoporos Int 18, 819–827 (2007). https://doi.org/10.1007/s00198-006-0307-7

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  • DOI: https://doi.org/10.1007/s00198-006-0307-7

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