Skip to main content
Top
Published in: Osteoporosis International 3/2003

01-03-2003 | Original Article

Cost-effectiveness of hip protectors in institutional dwelling elderly

Authors: Lisa Waldegger, Ann Cranney, Malcolm Man-Son-Hing, Doug Coyle

Published in: Osteoporosis International | Issue 3/2003

Login to get access

Abstract

Objective: To assess the effectiveness and cost-effectiveness of hip protectors in the prevention of hip fracture in an elderly population living in institutions. Design and setting: Meta-analysis followed by economic analysis. Methods: The meta-analysis of randomized controlled clinical trials was based on the recommendations of the Cochrane Collaboration. Model-based economic analysis was conducted using estimates of transition probabilities, costs, and utilities relevant to Canada. Results: The results indicate that hip protectors compared with control results in a relative risk of hip fracture of 0.40 (95% Confidence Interval 0.23–0.70). The economic analysis found that the use of hip protectors is expected to be both effective and cost saving. Results were robust to a range of analysis exploring the uncertainty of input parameters. Conclusions: There is sufficient clinical and economic evidence to support the use of hip protectors for institutional dwelling elderly.
Literature
1.
go back to reference Cooper C, Campion G, Melton LJ III (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(285):89 Cooper C, Campion G, Melton LJ III (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(285):89
2.
go back to reference Gulberg B, Johnell O, Kanis J (1997). World-wide projections for hip fracture. Osteoporos Int 7(407):13 Gulberg B, Johnell O, Kanis J (1997). World-wide projections for hip fracture. Osteoporos Int 7(407):13
3.
go back to reference Chandler JM, Zimmerman SI, Cirman DJ, Martine AR, Hawkes W, Hebel R et al (2000) Low bone mineral density and risk of fracture in white female nursing home residents. JAMA 284:972–977 Chandler JM, Zimmerman SI, Cirman DJ, Martine AR, Hawkes W, Hebel R et al (2000) Low bone mineral density and risk of fracture in white female nursing home residents. JAMA 284:972–977
4.
go back to reference Papaioannou A, Wiktorowicz M, Adachi JD, Goeree R, Papadimitropoulos E, Bedard M et al (2000) Mortality, independence in living, and re-fracture, one year following hip fracture in Canadians. J Soc Obstet Gynaecol Can 22:591–597 Papaioannou A, Wiktorowicz M, Adachi JD, Goeree R, Papadimitropoulos E, Bedard M et al (2000) Mortality, independence in living, and re-fracture, one year following hip fracture in Canadians. J Soc Obstet Gynaecol Can 22:591–597
5.
go back to reference Jagal S (1998) Osteoporosis fractures: incidence and impact. In: Badley E, Williams JI, editors. Patterns of health care in Ontario: arthritis and related conditions. North York: Institute for Clinical Evaluative Sciences, 143–156 Jagal S (1998) Osteoporosis fractures: incidence and impact. In: Badley E, Williams JI, editors. Patterns of health care in Ontario: arthritis and related conditions. North York: Institute for Clinical Evaluative Sciences, 143–156
6.
go back to reference Goeree R, O'Brien B, Pettitt D, Cuddy L, Ferraz M, Adachi J (1996) An assessment of the burden of illness due to osteoporosis in Canada. J Soc Obstet Gynaecol Can (Supplement):15–24 Goeree R, O'Brien B, Pettitt D, Cuddy L, Ferraz M, Adachi J (1996) An assessment of the burden of illness due to osteoporosis in Canada. J Soc Obstet Gynaecol Can (Supplement):15–24
7.
go back to reference Hawker G (1998) Epidemiology of arthritis and osteoporosis. In: Badley E, Williams JI (eds) Patterns of health care in Ontario: arthritis and related conditions. Institute for Clinical Evaluative Sciences, North York, pp 1–10 Hawker G (1998) Epidemiology of arthritis and osteoporosis. In: Badley E, Williams JI (eds) Patterns of health care in Ontario: arthritis and related conditions. Institute for Clinical Evaluative Sciences, North York, pp 1–10
8.
go back to reference Lauritzen JB, Petersen MM, Lund B (1993) Effect of external hip protectors on hip fractures. Lancet 341(8836):11–13 Lauritzen JB, Petersen MM, Lund B (1993) Effect of external hip protectors on hip fractures. Lancet 341(8836):11–13
9.
go back to reference Rubenstein LA, Josephson KR, Robbins AS (1994) Falls in a nursing home. Ann Intern Med 121:442–451 Rubenstein LA, Josephson KR, Robbins AS (1994) Falls in a nursing home. Ann Intern Med 121:442–451
10.
go back to reference 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 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
11.
go back to reference Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H et al (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65:183–187 Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H et al (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65:183–187
12.
go back to reference Greenspan SL, Myers ER, Kiel DP, Parker RA, Hayes WC, Resnick NM (1998) Fall direction, bone mineral density, and function: risk factors for hip fracture in frail nursing home elderly. Am J Med 104(6):539–545 Greenspan SL, Myers ER, Kiel DP, Parker RA, Hayes WC, Resnick NM (1998) Fall direction, bone mineral density, and function: risk factors for hip fracture in frail nursing home elderly. Am J Med 104(6):539–545
13.
go back to reference Hayes WC, Myers ER, Morris JN, Gerhart TN, Yett H, Lipsitz LA (1993) Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int 52(3):192–198 Hayes WC, Myers ER, Morris JN, Gerhart TN, Yett H, Lipsitz LA (1993) Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int 52(3):192–198
14.
go back to reference Kannus P, Parkkari J, Niemi S, Pasanen M, Palvanen M, Jarvinen M et al (2000) Prevention of hip fracture in elderly people with use of a hip protector. N Engl J Med 343(21):1506–1513 Kannus P, Parkkari J, Niemi S, Pasanen M, Palvanen M, Jarvinen M et al (2000) Prevention of hip fracture in elderly people with use of a hip protector. N Engl J Med 343(21):1506–1513
15.
go back to reference Parkkari J, Kannus P, Heikkila J, Poutala J, Sievanen H, Vuori I (1995) Energy-shunting external hip protector attenuates the peak femoral impact force below the theoretical fracture threshold: an in vitro biomechanical study under falling conditions of the elderly. J Bone Miner Res 10(10):1437–1442 Parkkari J, Kannus P, Heikkila J, Poutala J, Sievanen H, Vuori I (1995) Energy-shunting external hip protector attenuates the peak femoral impact force below the theoretical fracture threshold: an in vitro biomechanical study under falling conditions of the elderly. J Bone Miner Res 10(10):1437–1442
16.
go back to reference 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 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
17.
go back to reference Parker MJ, Gillespie LD, Gillespie WJ. Hip protectors for preventing hip fractures in the elderly (Cochrane Review). Cochrane Database of Systematic Reviews (computer file) 4:CD001255, 2000 Parker MJ, Gillespie LD, Gillespie WJ. Hip protectors for preventing hip fractures in the elderly (Cochrane Review). Cochrane Database of Systematic Reviews (computer file) 4:CD001255, 2000
18.
go back to reference Harada A, Mizuno M, Takemura M, Tokuda H, Okuizumi H, Niino N (2001) Hip fracture prevention trial using hip protectors in Japanese nursing homes. Osteoporos Int 12(3):215–221 Harada A, Mizuno M, Takemura M, Tokuda H, Okuizumi H, Niino N (2001) Hip fracture prevention trial using hip protectors in Japanese nursing homes. Osteoporos Int 12(3):215–221
19.
go back to reference Parker MJ, Gillespie LD, Gillespie WJ (2001) Hip protectors for preventing hip fractures in the elderly. Cochrane Database Syst Rev 2:CD001255 Parker MJ, Gillespie LD, Gillespie WJ (2001) Hip protectors for preventing hip fractures in the elderly. Cochrane Database Syst Rev 2:CD001255
20.
go back to reference Coyle D, Cranney A, Lee KM, Welch V, Tugwell P (2001) Cost-effectiveness of nasal calcitonin in postmenopausal women: using Cochrane collaboration methods for meta analysis in economic evaluation. Pharmacoeconomics 19:565–575 Coyle D, Cranney A, Lee KM, Welch V, Tugwell P (2001) Cost-effectiveness of nasal calcitonin in postmenopausal women: using Cochrane collaboration methods for meta analysis in economic evaluation. Pharmacoeconomics 19:565–575
21.
go back to reference CCOHTA (1997) Guidelines for economic evaluation of pharmaceuticals, 2d edn. CCOHTA, Ottawa CCOHTA (1997) Guidelines for economic evaluation of pharmaceuticals, 2d edn. CCOHTA, Ottawa
22.
go back to reference Papadimitropoulos E, Coyte PC, Josse RG, Greenwood CE (1997) Current and projected rates of hip fracture in Canada. CMAJ 157:1257–1363 Papadimitropoulos E, Coyte PC, Josse RG, Greenwood CE (1997) Current and projected rates of hip fracture in Canada. CMAJ 157:1257–1363
23.
go back to reference Melton III LJ, Atkinson EJ, Cooper C, O'Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10(3):214–221 Melton III LJ, Atkinson EJ, Cooper C, O'Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10(3):214–221
24.
go back to reference Statistics Canada (1995) Life Tables, Canada and Provinces, 1990–1992 (84–537 Occasional). Statistics Canada, Ottawa Statistics Canada (1995) Life Tables, Canada and Provinces, 1990–1992 (84–537 Occasional). Statistics Canada, Ottawa
25.
go back to reference Doubilet P, Begg CB, Weinstein MC, Braun P, McNeil BJ (1985) Probabilistic sensitivity analysis using monte carlo simulation: a practical approach. Med Decis Making 5(2):157–177 Doubilet P, Begg CB, Weinstein MC, Braun P, McNeil BJ (1985) Probabilistic sensitivity analysis using monte carlo simulation: a practical approach. Med Decis Making 5(2):157–177
26.
go back to reference Stinnett AA, Mullahy J (1998) Net health benefits: a framework for the analysis of uncertainty in cost-effective analysis. Med Decis Making 18(Suppl 2):S68–S80 Stinnett AA, Mullahy J (1998) Net health benefits: a framework for the analysis of uncertainty in cost-effective analysis. Med Decis Making 18(Suppl 2):S68–S80
27.
go back to reference Laupacis A, Feeny D, Tugwell PX (1992) How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ 146(4):473–481 Laupacis A, Feeny D, Tugwell PX (1992) How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ 146(4):473–481
28.
go back to reference Spiegelhalter DJ, Myles JP, Jones DR, Abrams KR (2000). Bayesian methods in health technology assessment: A review. Health Technol Assess 4(38):1–130 Spiegelhalter DJ, Myles JP, Jones DR, Abrams KR (2000). Bayesian methods in health technology assessment: A review. Health Technol Assess 4(38):1–130
29.
go back to reference Harada A, Okuizumi H (1998) Hip fracture prevention trial using hip protector in Japanese elderly. Osteoporos Int 8(Suppl 3), 121 Harada A, Okuizumi H (1998) Hip fracture prevention trial using hip protector in Japanese elderly. Osteoporos Int 8(Suppl 3), 121
30.
go back to reference Buckler JE, Dutton TL, MacLeod HL, Manuge MB, Nixon MD. Use of hip protectors on a dementia unit. Physiother Can 310(49):297–299 Buckler JE, Dutton TL, MacLeod HL, Manuge MB, Nixon MD. Use of hip protectors on a dementia unit. Physiother Can 310(49):297–299
31.
go back to reference Lauritzen JB, Hindso K, Petersen MM, Lund B (1996) Effect of hip protectors in falls on the hip and compliance. Osteoporosis 331–336 Lauritzen JB, Hindso K, Petersen MM, Lund B (1996) Effect of hip protectors in falls on the hip and compliance. Osteoporosis 331–336
32.
go back to reference Heikinheimo RJ (2001) External hip protectors in the aged in institutions and home. Congress of the International Association of Gerontology Heikinheimo RJ (2001) External hip protectors in the aged in institutions and home. Congress of the International Association of Gerontology
33.
go back to reference Chan DK, Hillier G, Coore M, Cooke R, Monk R, Mills J et al (2000) Effectiveness and acceptability of a newly designed hip protector: a pilot study. Arch Gerontol Geriatr 30(12):25–34 Chan DK, Hillier G, Coore M, Cooke R, Monk R, Mills J et al (2000) Effectiveness and acceptability of a newly designed hip protector: a pilot study. Arch Gerontol Geriatr 30(12):25–34
34.
go back to reference Ekman A, Mallmin H, Michaelsson K, Ljunghall S (1997) External hip protectors to prevent osteoporotic hip fractures. Lancet 350(9077):563–564 Ekman A, Mallmin H, Michaelsson K, Ljunghall S (1997) External hip protectors to prevent osteoporotic hip fractures. Lancet 350(9077):563–564
35.
go back to reference Jadad A, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12 Jadad A, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12
36.
go back to reference Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M et al (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352(9128):609–613 Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M et al (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352(9128):609–613
37.
go back to reference Specht-Leible N, Oster P (1999) Hip fracture with correctly positioned external hip protector. Age Ageing 28(5):497 Specht-Leible N, Oster P (1999) Hip fracture with correctly positioned external hip protector. Age Ageing 28(5):497
38.
go back to reference Cameron I, Kurrle S (1997) External hip protectors. J Am Geriatr Soc 45(9):1158 Cameron I, Kurrle S (1997) External hip protectors. J Am Geriatr Soc 45(9):1158
39.
go back to reference Villar M, Tracey A, Hill P, Inskip H, Thompson P, Cooper C (1998) Will elderly rest home residents wear hip protectors? Age Ageing 27(2):195–198 Villar M, Tracey A, Hill P, Inskip H, Thompson P, Cooper C (1998) Will elderly rest home residents wear hip protectors? Age Ageing 27(2):195–198
40.
go back to reference Hubacher M, Wettstein A (2001) Acceptance of hip protectors for hip fracture prevention in nursing homes. Osteoporosis Int 12:794–799 Hubacher M, Wettstein A (2001) Acceptance of hip protectors for hip fracture prevention in nursing homes. Osteoporosis Int 12:794–799
41.
go back to reference Haynes RB, McKibbon KA, Kanani R (1996) Systematic review of randomized trials of interventions to assist patients to follow prescriptions for medications. Lancet 348:383–386 Haynes RB, McKibbon KA, Kanani R (1996) Systematic review of randomized trials of interventions to assist patients to follow prescriptions for medications. Lancet 348:383–386
Metadata
Title
Cost-effectiveness of hip protectors in institutional dwelling elderly
Authors
Lisa Waldegger
Ann Cranney
Malcolm Man-Son-Hing
Doug Coyle
Publication date
01-03-2003
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 3/2003
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-002-1354-3

Other articles of this Issue 3/2003

Osteoporosis International 3/2003 Go to the issue