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A cost-benefit analysis of external hip protectors in the nursing home setting
Lisa A Honkanen1, Bruce R Schackman, Alvin I Mushlin
1Division of Geriatrics and Gerontology, Joan and Sanford Weill Medical College, Cornell University, New York, New York 10021, USA. lih2002@med.cornell.edu <lih2002@med.cornell.edu>
Objectives:
To estimate potential cost savings generated by a program of hip protectors in the nursing home from a Medicare perspective.
Design:
A state-transition Markov model considering short-term and long-term outcomes of hip protectors for a hypothetical nursing home population, stratified by age, sex, and functional status. Costs, transition probabilities between health states, and estimates of hip protectors' effectiveness were derived from published secondary data.
Setting:
Nursing home facilities in the United States.
Participants:
Hypothetical cohort of permanent nursing home residents aged 65 and older without a previous hip fracture.
Intervention:
Program of hip protectors reimbursed by Medicare.
Measurements:
Number of fractures, life years, and dollars saved.
Results:
Three pairs of hip protectors replaced annually would result in a weighted average lifetime absolute risk reduction for hip fracture of 8.5%, with net lifetime savings to Medicare of 223 dollars per resident. When the annual cost of hip protectors is less than 151 dollars per person, relative risk of fracture is less than or equal to 0.65 with hip protectors, or adherence is greater than 42%, hip protectors are cost saving to Medicare over a wide range of assumptions. Extrapolating these results to the estimated population of U.S. nursing home residents without a previous hip fracture, Medicare could save 136 million dollars in the first year of a hip-protector reimbursement program.
Conclusion:
From a Medicare perspective, hip protectors are a cost-saving intervention in the nursing home setting when hip protector effectiveness is less than or equal to 0.65 over the remaining lifetime of subjects.
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