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Cost-effectiveness of hip protectors in institutional dwelling elderly

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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.

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References

  1. Cooper C, Campion G, Melton LJ III (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(285):89

    Google Scholar 

  2. Gulberg B, Johnell O, Kanis J (1997). World-wide projections for hip fracture. Osteoporos Int 7(407):13

    Google Scholar 

  3. 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

    Google Scholar 

  4. 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

    Google Scholar 

  5. 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. 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. 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. Lauritzen JB, Petersen MM, Lund B (1993) Effect of external hip protectors on hip fractures. Lancet 341(8836):11–13

    Google Scholar 

  9. Rubenstein LA, Josephson KR, Robbins AS (1994) Falls in a nursing home. Ann Intern Med 121:442–451

    Google Scholar 

  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

    Google Scholar 

  11. 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

    Google Scholar 

  12. 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

    Google Scholar 

  13. 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

    Google Scholar 

  14. 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

    Google Scholar 

  15. 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

    Google Scholar 

  16. 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

    Google Scholar 

  17. 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. 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

    Google Scholar 

  19. Parker MJ, Gillespie LD, Gillespie WJ (2001) Hip protectors for preventing hip fractures in the elderly. Cochrane Database Syst Rev 2:CD001255

  20. 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

    Google Scholar 

  21. CCOHTA (1997) Guidelines for economic evaluation of pharmaceuticals, 2d edn. CCOHTA, Ottawa

  22. Papadimitropoulos E, Coyte PC, Josse RG, Greenwood CE (1997) Current and projected rates of hip fracture in Canada. CMAJ 157:1257–1363

    Google Scholar 

  23. Melton III LJ, Atkinson EJ, Cooper C, O'Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10(3):214–221

    Google Scholar 

  24. Statistics Canada (1995) Life Tables, Canada and Provinces, 1990–1992 (84–537 Occasional). Statistics Canada, Ottawa

  25. 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

    Google Scholar 

  26. 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

    Google Scholar 

  27. 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

    Google Scholar 

  28. Spiegelhalter DJ, Myles JP, Jones DR, Abrams KR (2000). Bayesian methods in health technology assessment: A review. Health Technol Assess 4(38):1–130

    Google Scholar 

  29. Harada A, Okuizumi H (1998) Hip fracture prevention trial using hip protector in Japanese elderly. Osteoporos Int 8(Suppl 3), 121

    Google Scholar 

  30. 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. Lauritzen JB, Hindso K, Petersen MM, Lund B (1996) Effect of hip protectors in falls on the hip and compliance. Osteoporosis 331–336

  32. Heikinheimo RJ (2001) External hip protectors in the aged in institutions and home. Congress of the International Association of Gerontology

  33. 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

    Google Scholar 

  34. Ekman A, Mallmin H, Michaelsson K, Ljunghall S (1997) External hip protectors to prevent osteoporotic hip fractures. Lancet 350(9077):563–564

    Google Scholar 

  35. 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

    Google Scholar 

  36. 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

    Google Scholar 

  37. Specht-Leible N, Oster P (1999) Hip fracture with correctly positioned external hip protector. Age Ageing 28(5):497

    Google Scholar 

  38. Cameron I, Kurrle S (1997) External hip protectors. J Am Geriatr Soc 45(9):1158

    Google Scholar 

  39. 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

    Google Scholar 

  40. Hubacher M, Wettstein A (2001) Acceptance of hip protectors for hip fracture prevention in nursing homes. Osteoporosis Int 12:794–799

    Google Scholar 

  41. 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

    Google Scholar 

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Authors and Affiliations

  1. Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada

    Lisa Waldegger, Malcolm Man-Son-Hing & Doug Coyle

  2. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Malcolm Man-Son-Hing & Doug Coyle

  3. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Doug Coyle

  4. Department of Medicine, Queen's University at Kingston, Kingston, Ontario, Canada

    Ann Cranney

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  1. Lisa Waldegger
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  2. Ann Cranney
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  3. Malcolm Man-Son-Hing
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  4. Doug Coyle
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Correspondence to Doug Coyle.

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Waldegger, L., Cranney, A., Man-Son-Hing, M. et al. Cost-effectiveness of hip protectors in institutional dwelling elderly. Osteoporos Int 14, 243–250 (2003). https://doi.org/10.1007/s00198-002-1354-3

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  • DOI: https://doi.org/10.1007/s00198-002-1354-3

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