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Mahalingam M, Peterson C, Bergen G. Systematic review of unintentional injury prevention economic evaluations 2010-2019 and comparison to 1998-2009. ACCIDENT; ANALYSIS AND PREVENTION 2020; 146:105688. [PMID: 32911130 PMCID: PMC7554223 DOI: 10.1016/j.aap.2020.105688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Health economic evaluation studies (e.g., cost-effectiveness analysis) can provide insight into which injury prevention interventions maximize available resources to improve health outcomes. A previous systematic review summarized 48 unintentional injury prevention economic evaluations published during 1998-2009, providing a valuable overview of that evidence for researchers and decisionmakers. The aim of this study was to summarize the content and quality of recent (2010-2019) economic evaluations of unintentional injury prevention interventions and compare to the previous publication period (1998-2009). METHODS Peer-reviewed English-language journal articles describing public health unintentional injury prevention economic evaluations published January 1, 2010 to December 31, 2019 were identified using index terms in multiple databases. Injury causes, interventions, study methods, and results were summarized. Reporting on key methods elements (e.g., economic perspective, time horizon, discounting, currency year, etc.) was assessed. Reporting quality was compared between the recent and previous publication periods. RESULTS Sixty-eight recent economic evaluation studies were assessed. Consistent with the systematic review on this topic for the previous publication period, falls and motor vehicle traffic injury prevention were the most common study subjects. Just half of studies from the recent publication period reported all key methods elements, although this represents an improvement compared to the previous publication period (25 %). CONCLUSION Most economic evaluations of unintentional injury prevention interventions address just two injury causes. Better adherence to health economic evaluation reporting standards may enhance comparability across studies and increase the likelihood that this type of evidence is included in decision-making related to unintentional injury prevention.
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Affiliation(s)
- Mallika Mahalingam
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, Atlanta, GA, 30341, United States.
| | - Cora Peterson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, Atlanta, GA, 30341, United States
| | - Gwen Bergen
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, Atlanta, GA, 30341, United States
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de Bot RTAL, Veldman HD, Witlox AM, van Rhijn LW, Hiligsmann M. Hip protectors are cost-effective in the prevention of hip fractures in patients with high fracture risk. Osteoporos Int 2020; 31:1217-1229. [PMID: 32040600 DOI: 10.1007/s00198-019-05252-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/29/2019] [Indexed: 12/01/2022]
Abstract
Cost-effective preventive interventions are necessary for tackling the increasing number of hip fractures, which are frequently occuring as a serious consequence of osteoporosis. Several interventions have been available for preventing and treating osteoporosis. The aim of this study was to systematically review and critically appraise studies that assessed cost-effectiveness of hip protectors for the prevention of hip fractures and to investigate the effects of age, gender and residence situation on cost-effectiveness. A systematic review was conducted in order to identify economic evaluation studies examining the hip protector solely or compared to no treatment according to the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Synthesis of results was performed to observe trends between the studies. Methodological quality of the studies was assessed by the use of the Quality of Health Economic Studies (QHES) instrument. A total of 15 economic evaluation studies were included for analysis. The methodological quality was high in most studies (13/15). The hip protector was solely evaluated in three studies and within 12 other studies compared with no intervention. All studies that investigated the cost-effectiveness in long-term care facilities revealed that hip protector use is a cost-effective strategy for the prevention of hip fractures in elderly. Cost-effectiveness was also observed in two studies that provided hip protectors in a geriatric hospital ward. Four studies included both community-dwelling residents and residents living in a long-term care facility in their study. These studies showed more variability regarding cost-effectiveness. One study did not report information regarding the residence situation of their cohort, but also observed cost-effectiveness. In conclusion, this review suggests that hip protectors are a cost-effective approach in the prevention of hip fractures in populations with high risk of hip fractures especially in long-term care facilities and a geriatric ward in a hospital.
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Affiliation(s)
- R T A L de Bot
- Department of Orthopaedics, Maastricht University Medical Center, P. Debyelaan 25, NL-6202 AZ, Maastricht, The Netherlands.
- Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, Maastricht University, P.O. Box 616, NL-6200 MD, Maastricht, The Netherlands.
| | - H D Veldman
- Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, Maastricht University, P.O. Box 616, NL-6200 MD, Maastricht, The Netherlands
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center Heerlen, H. Dunantstraat 5, NL-6419 PC, Heerlen, The Netherlands
| | - A M Witlox
- Department of Orthopaedics, Maastricht University Medical Center, P. Debyelaan 25, NL-6202 AZ, Maastricht, The Netherlands
| | - L W van Rhijn
- Department of Orthopaedics, Maastricht University Medical Center, P. Debyelaan 25, NL-6202 AZ, Maastricht, The Netherlands
| | - M Hiligsmann
- Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, Maastricht University, P.O. Box 616, NL-6200 MD, Maastricht, The Netherlands
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Abstract
OBJECTIVE To evaluate the cost-effectiveness of routine administration of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA. DESIGN Markov cohort simulation model based on published literature from a healthcare sector perspective over a lifetime horizon. SETTING Nursing homes. PARTICIPANTS A hypothetical cohort of nursing home residents aged 85 years with osteoporosis. INTERVENTIONS Two strategies were compared: (1) a single intravenous dose of zoledronic acid 5 mg and (2) usual care (supplementation of calcium and vitamin D only). PRIMARY AND SECONDARY OUTCOME MEASURES Incremental cost-effectiveness ratio (ICER), as measured by cost per quality-adjusted life year (QALY) gained. RESULTS Compared with usual care, zoledronic acid had an ICER of $207 400 per QALY gained and was not cost-effective at a conventional willingness-to-pay threshold of $100 000 per QALY gained. The results were robust to a reasonable range of assumptions about incidence, mortality, quality-of-life effects and the cost of hip fracture and the cost of zoledronic acid. Zoledronic acid had a potential to become cost-effective if a fracture risk reduction with zoledronic acid was higher than 23% or if 6-month mortality in nursing home residents was lower than 16%. Probabilistic sensitivity analysis showed that the zoledronic acid would be cost-effective in 14%, 27% and 44% of simulations at willingness-to-pay thresholds of $50 000, $100 000 or $200 000 per QALY gained, respectively. CONCLUSIONS Routine administration of single-dose zoledronic acid in nursing home residents with osteoporosis is not a cost-effective use of resources in the USA but could be justifiable in those with a favourable life expectancy.
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Affiliation(s)
- Kouta Ito
- Department of Medicine, Hebrew SeniorLife, Roslindale, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Korall AMB, Godin J, Feldman F, Cameron ID, Leung PM, Sims-Gould J, Robinovitch SN. Validation and psychometric properties of the commitment to hip protectors (C-HiP) index in long-term care providers of British Columbia, Canada: a cross-sectional survey. BMC Geriatr 2017; 17:103. [PMID: 28468679 PMCID: PMC5415742 DOI: 10.1186/s12877-017-0493-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND If worn during a fall, hip protectors substantially reduce risk for hip fracture. However, a major barrier to their clinical efficacy is poor user adherence. In long-term care, adherence likely depends on how committed care providers are to hip protectors, but empirical evidence is lacking due to the absence of a psychometrically valid assessment tool. METHODS We conducted a cross-sectional survey in a convenience sample of 529 paid care providers. We developed the 15-item C-HiP Index to measure commitment, comprised of three subscales: affective, cognitive and behavioural. Responses were subjected to hierarchical factor analysis and internal consistency testing. Eleven experts rated the relevance and clarity of items on 4-point Likert scales. We performed simple linear regression to determine whether C-HiP Index scores were positively related to the question, "Do you think of yourself as a champion of hip protectors", rated on a 5-point Likert scale. We examined whether the C-HiP Index could differentiate respondents: (i) who were aware of a protected fall causing hip fracture from those who were unaware; (ii) who agreed in the existence of a champion of hip protectors within their home from those who didn't. RESULTS Hierarchical factor analysis yielded two lower-order factors and a single higher-order factor, representing the overarching concept of commitment to hip protectors. Items from affective and cognitive subscales loaded highest on the first lower-order factor, while items from the behavioural subscale loaded highest on the second. We eliminated one item due to low factor matrix coefficients, and poor expert evaluation. The C-HiP Index had a Cronbach's alpha of 0.96. A one-unit increase in championing was associated with a 5.2-point (p < 0.01) increase in C-HiP Index score. Median C-HiP Index scores were 4.3-points lower (p < 0.01) among respondents aware of a protected fall causing hip fracture, and 7.0-points higher (p < 0.01) among respondents who agreed in the existence of a champion of hip protectors within their home. CONCLUSIONS We offer evidence of the psychometric properties of the C-HiP Index. The development of a valid and reliable assessment tool is crucial to understanding the factors that govern adherence to hip protectors in long-term care.
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Affiliation(s)
- Alexandra M B Korall
- Injury Prevention and Mobility Laboratory (IPML), Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,Centre for Hip Health and Mobility, 7th Floor, 2635 Laurel Street, Vancouver, V5Z 1M9, BC, Canada.
| | - Judith Godin
- Geriatric Medicine Research Unit, Nova Scotia Health Authority, 5955 Veteran's Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Fabio Feldman
- Injury Prevention and Mobility Laboratory (IPML), Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,Patient Safety and Injury Prevention, Fraser Health Authority, Suite 400, 13450 102nd Avenue, Surry, BC, V3T 5X3, Canada
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, 2065, Australia
| | - Pet-Ming Leung
- Patient Safety and Injury Prevention, Fraser Health Authority, Suite 400, 13450 102nd Avenue, Surry, BC, V3T 5X3, Canada.,New Vista Care Home, 7550 Rosewood Street, Burnaby, BC, V5E 3Z3, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, 7th Floor, 2635 Laurel Street, Vancouver, V5Z 1M9, BC, Canada.,Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Stephen N Robinovitch
- Injury Prevention and Mobility Laboratory (IPML), Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,Centre for Hip Health and Mobility, 7th Floor, 2635 Laurel Street, Vancouver, V5Z 1M9, BC, Canada
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Korall AMB, Feldman F, Scott VJ, Wasdell M, Gillan R, Ross D, Thompson-Franson T, Leung PM, Lin L. Facilitators of and barriers to hip protector acceptance and adherence in long-term care facilities: a systematic review. J Am Med Dir Assoc 2016; 16:185-93. [PMID: 25704127 DOI: 10.1016/j.jamda.2014.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hip protectors represent an attractive strategy for reducing hip fractures among high-risk fallers in long-term care facilities. However, clinical studies yield conflicting results regarding their clinical value. This is mainly due to poor acceptance and adherence among users in wearing these devices. As a result, there is an urgent need to identify potential barriers and facilitators to initial acceptance and continued adherence with hip protector use. PURPOSE The objective of this systematic review is to synthesize available research evidence to identify factors that influence acceptance and adherence among older adults living in long-term care facilities. METHODS A key word search was conducted for studies published in English between 2000 and 2013 that employed quantitative, qualitative, or mixed-methods research designs. Two independent reviewers evaluated each article for inclusion, with a third reviewer when needed to resolve discrepancies. RESULTS Twenty-eight articles met our inclusion criteria, and facilitators and barriers were clustered into 4 socio-ecological levels: system (eg, facility commitment, staff shortages), caregiver (eg, belief in the efficacy of protectors, negative perceptions), resident (eg, clinical risk factors for falls and related fractures, acute illness), and product (eg, soft shell, discomfort). DISCUSSION The outcomes provide decision makers, health professionals, and caregivers with a greater awareness of strategies to improve compliance with the use of hip protectors. Furthermore, researchers can use this information to design clinical trials that yield high acceptance and adherence.
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Affiliation(s)
- Alexandra M B Korall
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada; Older Adult Program, Fraser Health Authority, Surrey, Canada.
| | - Vicky J Scott
- British Columbia Injury Research and Prevention Unit, Vancouver, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Michael Wasdell
- Research and Academics, Ontario Shores Centre for Mental Health Sciences, Ontario, Canada
| | | | | | | | - Pet-Ming Leung
- Older Adult Program, Fraser Health Authority, Surrey, Canada
| | - Lisa Lin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
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Church JL, Haas MR, Goodall S. Cost Effectiveness of Falls and Injury Prevention Strategies for Older Adults Living in Residential Aged Care Facilities. PHARMACOECONOMICS 2015; 33:1301-1310. [PMID: 26242882 DOI: 10.1007/s40273-015-0313-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the cost effectiveness of interventions designed to prevent falls and fall-related injuries among older people living in residential aged care facilities (RACFs) from an Australian health care perspective. METHODS A decision analytic Markov model was developed that stratified individuals according to their risk of falling and accounted for the risk of injury following a fall. The effectiveness of the interventions was derived from two Cochrane reviews of randomized controlled trials for falls/fall-related injury prevention in RACFs. Interventions were considered effective if they reduced the risk of falling or reduced the risk of injury following a fall. The interventions that were modelled included vitamin D supplementation, annual medication review, multifactorial intervention (a combination of risk assessment, medication review, vision assessment and exercise) and hip protectors. The cost effectiveness was calculated as the incremental cost relative to the incremental benefit, in which the benefit was estimated using quality-adjusted life-years (QALYs). Uncertainty was explored using univariate and probabilistic sensitivity analysis. RESULTS Vitamin D supplementation and medication review both dominated 'no intervention', as these interventions were both more effective and cost saving (because of healthcare costs avoided). Hip protectors are dominated (less effective and more costly) by vitamin D and medication review. The incremental cost-effectiveness ratio (ICER) for medication review relative to vitamin D supplementation is AU$2442 per QALY gained, and the ICER for multifactorial intervention relative to medication review is AU$1,112,500 per QALY gained. The model is most sensitive to the fear of falling and the cost of the interventions. CONCLUSION The model suggests that vitamin D supplementation and medication review are cost-effective interventions that reduce falls, provide health benefits and reduce health care costs in older adults living in RACFs.
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Affiliation(s)
- Jody L Church
- Centre for Health Economics Research and Evaluation, UTS Business School, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Marion R Haas
- Centre for Health Economics Research and Evaluation, UTS Business School, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, UTS Business School, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
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Cianferotti L, Fossi C, Brandi ML. Hip Protectors: Are They Worth it? Calcif Tissue Int 2015; 97:1-11. [PMID: 25926045 DOI: 10.1007/s00223-015-0002-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/11/2015] [Indexed: 01/04/2023]
Abstract
Hip fractures are one of the most serious conditions in frail elderly subjects, greatly increasing morbidity and mortality, and decreasing healthy life years. Since their first introduction on the market, hip protectors have been revealed to be a potential preventive measure for hip fractures, in addition to other well-known recognized medical interventions and rehabilitation procedures. However, randomized controlled trials have given contradictory results regarding their efficacy. Moreover, little data are available on the cost effectiveness of hip protectors. Adherence is a major problem in assessing the effectiveness of hip protectors in preventing fractures. Indeed, there is a lack of general consensus on a standard definition and quantitative objective estimation of adherence to hip protectors, along with still scarce evidence on specific interventions on how to ameliorate it. From what is known so far, it seems reasonable to advise the use of hip protectors in aged care facilities, since recent pooled analyses have suggested their efficacy in this setting. The introduction of sensors combined with hip protectors will probably address this issue, both for monitoring and optimizing compliance, especially in elderly people. In the meantime, new, well-designed studies following specific guidelines are strongly encouraged and needed. In particular, studies in community-dwelling elderly individuals at high risk of first or further fragility fractures are required. The optimization of the tested devices in a preclinical setting according to international standard biomechanical testing is necessary.
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Affiliation(s)
- Luisella Cianferotti
- Department of Surgery and Translational Medicine, Section of Endocrinology, Unit of Bone and Mineral Metabolism, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy,
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Santesso N, Carrasco‐Labra A, Brignardello‐Petersen R. Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev 2014; 2014:CD001255. [PMID: 24687239 PMCID: PMC10754476 DOI: 10.1002/14651858.cd001255.pub5] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Older people living in nursing care facilities or older adults living at home are at high risk of falling and a hip fracture may occur after a fall. Hip protectors have been advocated as a means to reduce the risk of hip fracture. Hip protectors are plastic shields (hard) or foam pads (soft), usually fitted in pockets in specially designed underwear.This is an update of a Cochrane review first published in 1999, and updated several times, most recently in 2010. OBJECTIVES To determine if the provision of external hip protectors (sometimes referred to as hip pads or hip protector pads) reduces the risk of fracturing the hip in older people. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12), MEDLINE (1950 to week 3 November 2012), MEDLINE In-Process (18 December 2012), EMBASE (1988 to 2012 Week 50), CINAHL (1982 to December 2012), BioMed Central (January 2010), trial registers and reference lists of relevant articles. SELECTION CRITERIA All randomised or quasi-randomised controlled trials comparing an intervention group provided with hip protectors with a control group not provided with hip protectors. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias and extracted data. We sought additional information from trialists. Data were pooled using fixed-effect or random-effects models as appropriate. MAIN RESULTS This review includes 19 studies, nine of which were cluster randomised. These included approximately 17,000 people (mean age range 78 to 86 years). Most studies were overall at low risk of bias for fracture outcomes. Trials tested hard or soft hip protectors enclosed in special underwear in 18 studies.Pooling of data from 14 studies (11,808 participants) conducted in nursing or residential care settings found moderate quality evidence for a small reduction in hip fracture risk (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.67 to 1.00); the absolute effect is 11 fewer people (95% CI, from 20 fewer to 0) per 1000 having a hip fracture when provided with hip protectors.There is moderate quality evidence when pooling data from five trials in the community (5614 participants) that shows little or no effect in hip fracture risk (RR 1.15, 95% CI 0.84 to 1.58); the absolute effect is two more people (95% CI 2 fewer to 6 more) per 1000 people having a hip fracture when provided with hip protectors.There is probably little to no effect on falls (rate ratio 1.02, 95% CI 0.9 to 1.16) or fractures other than of the hip or pelvis (rate ratio 0.87, 95% CI 0.71 to 1.07). However, the risk ratio for pelvic fractures is RR 1.27 (95% CI 0.78 to 2.08); this is an absolute effect of one more person (95% CI 1 fewer to 5 more) per 1000 having a pelvic fracture when provided with hip protectors.The incidence of adverse events while wearing hip protectors, including skin irritation, ranged from 0% to 5%. Adherence, particularly in the long term, was poor. AUTHORS' CONCLUSIONS Hip protectors probably reduce the risk of hip fractures if made available to older people in nursing care or residential care settings, without increasing the frequency of falls. However, hip protectors may slightly increase the small risk of pelvic fractures. Poor acceptance and adherence by older people offered hip protectors is a barrier to their use. Better understanding is needed of the personal and design factors that may influence acceptance and adherence.
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Affiliation(s)
- Nancy Santesso
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHamiltonOntarioCanadaL8N 3Z5
| | - Alonso Carrasco‐Labra
- Faculty of Dentistry, University of ChileEvidence Based Dentistry UnitSergio Livingstone Pohlhammer 943, IndependenciaSantiagoChile8380000
| | - Romina Brignardello‐Petersen
- Faculty of Dentistry, University of ChileEvidence Based Dentistry UnitSergio Livingstone Pohlhammer 943, IndependenciaSantiagoChile8380000
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Polinder S, Segui-Gomez M, Toet H, Belt E, Sethi D, Racioppi F, van Beeck EF. Systematic review and quality assessment of economic evaluation studies of injury prevention. ACCIDENT; ANALYSIS AND PREVENTION 2012; 45:211-221. [PMID: 22269503 DOI: 10.1016/j.aap.2011.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 06/28/2011] [Accepted: 07/05/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To review and assess the quality of economic evaluation studies on injury prevention measures. DESIGN Systematic review. DATA SOURCES Electronic databases searched included Medline (Pubmed), EMBASE, Web of Science, PsycINFO, and Safetylit. INCLUSION CRITERIA Empirical studies published in English in international peer-reviewed journals in the period 1998-2009. The subject of the study was economic evaluation of prevention of unintentional injury. Cost-effectiveness (CEA), cost-benefit (CBA) and cost utility (CUA) analyses were included. METHODS Methodological details, study designs, and analysis and interpretation of results of the included articles were reviewed and extracted into summary tables. Study quality was judged using the criteria recommended by the Panel on cost-effectiveness in health and medicine and the British Medical Journal (BMJ) checklist for economic evaluations. RESULTS Forty-eight studies met the inclusion criteria of our review. Interventions assessed most frequently were hip protectors and exercise programs for the elderly. A wide variety of methodological approaches was found, including differences in type of economic evaluation, perspective, time horizon, study design, cost categories, effect outcomes, and adjustments for timing and uncertainty used. The majority of studies performed a cost-effectiveness analysis from a societal perspective with a time horizon of one to five years, in which the effect was expressed in terms of injuries prevented and only direct health care costs were included. Most studies deviated from one or more of the Panel recommendations or BMJ guidelines; e.g. not adopting the societal perspective, not including all relevant costs, no incremental analysis. CONCLUSIONS This review has shown that approaches to economic evaluation of injury prevention vary widely and most studies do not fulfill methodological rigour. Improving quality and harmonization of economic evaluation studies in the field of injury prevention is needed. One way of achieving this would be to establish international guidelines on economic evaluation for injury prevention interventions, based on established economic evaluation checklists, to assist researchers in the design and reporting of economic evaluations.
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Affiliation(s)
- Suzanne Polinder
- Erasmus Medical Center, Department of Public Health, Rotterdam, The Netherlands.
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Kasturi GC, Adler RA. Osteoporosis: nonpharmacologic management. PM R 2011; 3:562-72. [PMID: 21478069 DOI: 10.1016/j.pmrj.2010.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 12/10/2010] [Accepted: 12/17/2010] [Indexed: 01/01/2023]
Abstract
Osteoporosis is a chronic disorder of the skeleton causing increased bone fragility and fractures. In the second of our 3-part series, we discuss the beneficial effects of nonpharmacologic agents in the management of osteoporosis. We review the evidence supporting the use of exercise, whole-body vibration, hip protectors, low-intensity pulsed ultrasound, bracing, and vertebral augmentation procedures. The mechanism of action, precautions, and expected outcomes are discussed. Nonpharmacologic management of osteoporosis blends in very well with an overall exercise prescription. The nonpharmacologic interventions discussed are readily available and easy to implement. The use of such techniques demonstrates the important role of the physiatrist in the management of osteoporosis.
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Affiliation(s)
- Gopi C Kasturi
- Department of Neurology/Rehabilitation, VA Central California Health Care System, 2615 E Clinton Ave, Fresno, CA 93703, USA.
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Price MJ, Welton NJ, Briggs AH, Ades AE. Model averaging in the presence of structural uncertainty about treatment effects: influence on treatment decision and expected value of information. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:205-218. [PMID: 21402291 DOI: 10.1016/j.jval.2010.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 08/27/2010] [Accepted: 08/30/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Standard approaches to estimation of Markov models with data from randomized controlled trials tend either to make a judgment about which transition(s) treatments act on, or they assume that treatment has a separate effect on every transition. An alternative is to fit a series of models that assume that treatment acts on specific transitions. Investigators can then choose among alternative models using goodness-of-fit statistics. However, structural uncertainty about any chosen parameterization will remain and this may have implications for the resulting decision and the need for further research. METHODS We describe a Bayesian approach to model estimation, and model selection. Structural uncertainty about which parameterization to use is accounted for using model averaging and we developed a formula for calculating the expected value of perfect information (EVPI) in averaged models. Marginal posterior distributions are generated for each of the cost-effectiveness parameters using Markov Chain Monte Carlo simulation in WinBUGS, or Monte-Carlo simulation in Excel (Microsoft Corp., Redmond, WA). We illustrate the approach with an example of treatments for asthma using aggregate-level data from a connected network of four treatments compared in three pair-wise randomized controlled trials. RESULTS The standard errors of incremental net benefit using structured models is reduced by up to eight- or ninefold compared to the unstructured models, and the expected loss attaching to decision uncertainty by factors of several hundreds. Model averaging had considerable influence on the EVPI. CONCLUSIONS Alternative structural assumptions can alter the treatment decision and have an overwhelming effect on model uncertainty and expected value of information. Structural uncertainty can be accounted for by model averaging, and the EVPI can be calculated for averaged models.
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Affiliation(s)
- Malcolm J Price
- School of Social and Community-Based Medicine, University of Bristol, Bristol, UK.
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12
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Abstract
BACKGROUND Hip fracture in older people usually results from a fall on the hip. Hip protectors have been advocated as a means to reduce the risk of hip fracture. OBJECTIVES To determine if external hip protectors reduce the incidence of hip fractures in older people following a fall. SEARCH STRATEGY We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2010), The Cochrane Library 2010, Issue 2, MEDLINE (1950 to November 2009), MEDLINE in-process (30 December 2009), EMBASE (1988 to 2009 week 52), CINAHL (1982 to February 2009), BioMed Central (January 2010) and reference lists of relevant articles. SELECTION CRITERIA All randomised or quasi-randomised controlled trials comparing the use of hip protectors with an unprotected control group. DATA COLLECTION AND ANALYSIS Two authors independently assessed risk of bias and extracted data. We sought additional information from trialists. Data were pooled using fixed-effect or random-effects models as appropriate. MAIN RESULTS Pooling of data from 13 studies (11,573 participants) conducted in nursing or residential care settings found a marginally significant reduction in hip fracture risk (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.66 to 0.99); statistical significance was lost following exclusion of five studies (3757 participants) assessed at high risk of bias (RR 0.93, 95% CI 0.74 to 1.18).Pooling of data from three trials (5135 community-dwelling participants) showed no evidence of reduction in hip fracture risk (RR 1.14, 95% CI 0.83 to 1.57).There was no evidence of a statistically significant effect on incidence of pelvic or other fractures, or on rate of falls. No important adverse effects of the hip protectors were reported but adherence, particularly in the long term, was poor. AUTHORS' CONCLUSIONS The effectiveness of the provision of hip protectors in reducing the incidence of hip fracture in older people is still not clearly established, although they may reduce the rate of hip fractures if made available to frail older people in nursing care. It remains unknown from studies identified to date if these findings apply to all types of hip protectors. Some cluster-randomised trials have been associated with high risk of bias. Poor acceptance and adherence by older people offered hip protectors have been key factors contributing to the continuing uncertainty.
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Affiliation(s)
- William J Gillespie
- Hull York Medical School, University of Hull, Cottingham Road, Hull, UK, HU6 7RX
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Parkkari J, Kannus P. Hip protectors for preventing hip fractures among elderly adults. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/ahe.09.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Prevention of fractures in the elderly consists of prevention and treatment of osteoporosis, prevention of falling and prevention of fractures using injury-site protection. Since the majority of hip fractures in elderly people are caused by a sideways fall with direct impact on the greater trochanter of the proximal femur, one option to prevent the fracture is a biomechanically effective external hip protector. The biomechanical test results of an energy-shunting and energy-absorbing hip protector have demonstrated that this type of hip protector can provide an effective impact force attenuation in typical falling conditions of older adults by reducing the initial force down to the seventh part. Recent meta-analyses and systematic reviews combining findings of all different types of hip protectors suggest that in care homes and institutions with high rates of hip fracture, the use of hip protectors might help to reduce the risk of fracture to 20–60%, but there is no evidence of a public health level benefit from hip protectors for lower-risk (usually home-dwelling) elderly people.
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Affiliation(s)
- Jari Parkkari
- Chief Physician, Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, and, Research Unit of Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - Pekka Kannus
- Injury & Osteoporosis Research Center, UKK Institute for Health Promotion Research, and, Medical School, University of Tampere, and, Division of Orthopaedics & Traumatology, Department of Trauma, Musculoskeletal Surgery & Rehabilitation, Tampere University Hospital, Tampere, Finland
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Gandjour A, Weyler EJ. Cost-effectiveness of preventing hip fractures by hip protectors in elderly institutionalized residents in Germany. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:1088-1095. [PMID: 19602215 DOI: 10.1111/j.1524-4733.2008.00393.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To determine the long-term cost-effectiveness of hip protector use in the prevention of hip fractures in elderly institutionalized residents in Germany compared to no prevention. METHODS A lifetime Markov decision model was developed using published data on costs and health outcomes. A societal and statutory health insurance perspective was adopted. RESULTS From a societal/statutory health insurance perspective, use of hip protectors yields savings of 315 EURO/257 EURO and a gain of 0.13 quality-adjusted life years per person over lifetime. CONCLUSION Hip protector use in elderly institutionalized residents in Germany is highly cost-effective.
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Affiliation(s)
- Afschin Gandjour
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany.
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Bajo L, Arnau A, Espaulella J, Dalmau N, Barneto M. [Acceptability and compliance with the use of hip protectors in elderly patients with dementia admitted to a psychogeriatric unit]. Rev Esp Geriatr Gerontol 2008; 43:346-352. [PMID: 19080950 DOI: 10.1016/s0211-139x(08)75189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To detect the percentage of patients with dementia admitted to a psychogeriatric department, who have a high risk of falls, and to evaluate acceptance and compliance with hip protectors during their stay in hospital and 2 weeks and 3 months after discharge. MATERIAL AND METHODS We performed a hospital-based prospective cohort study. Risk of falling was evaluated on the basis of immediate bipedal standing instability or abnormal semi-tandem posture, a get-up-and-go test time of more than 20 seconds, or clinical judgement. Compliance during hospital stay was evaluated through nursing records and compliance outside hospital by telephone interviews at 15 days and 3 months after discharge. RESULTS A total of 115 patients consecutively admitted to the psychogeriatric department of the Santa Creu Hospital in Vic were assessed. Sixty patients (52.2%) were excluded from the study, the main reason being dependence on another person for walking. Of the 55 patients included, 44 (80.0%) had a high risk of falls and were candidates for hip protectors. In-hospital compliance was 80.5% (95% CI: 65.1-91.2). The most common cause of non-compliance was removal of the hip protector by the patient. Compliance after discharge was 64.5% (95% CI: 45.4-80.8) at 2 weeks and 57.1% (95% CI: 28.9-82.4) at 3 months. CONCLUSIONS A high risk of falling was found in a large percentage of patients with dementia who were not dependent on others for walking. Compliance was not a problem in the use of hip protectors in a high-risk population in the hospital-admission setting but was weaker in the community setting.
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Affiliation(s)
- Lorena Bajo
- Unidad de Psicogeriatría, Hospital de la Santa Creu, Vic, Barcelona, Spain
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Die Bedeutung von Hüftprotektoren zur Prävention von hüftnahen Frakturen bei älteren Menschen. Wien Med Wochenschr 2007; 157:381-7. [DOI: 10.1007/s10354-007-0384-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 11/21/2006] [Indexed: 10/22/2022]
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Finkelstein E, Prabhu M, Chen H. Increased prevalence of falls among elderly individuals with mental health and substance abuse conditions. Am J Geriatr Psychiatry 2007; 15:611-9. [PMID: 17586785 DOI: 10.1097/jgp.0b013e318033ed97] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To quantify the increase in the likelihood of a fall injury and medical costs of treating fall injuries among elderly individuals with select mental health (MH), substance abuse (SA), and cognitive disorders compared with the general elderly population. METHODS The authors used a random sample (N = 601,922) of claimants in the 2001 Medicare fee-for-service 5% Standard Analytic File. Using logistic regressions, the authors estimated the odds of sustaining a medically attended fall injury as a function of each MH, cognitive, and SA condition and select demographic characteristics. The authors also used an ordinary least squares regression model to compare the increase in costs associated with fall injuries for those with MH/SA conditions compared to those without MH/SA conditions. RESULTS The odds of a fall injury are between 1.5 and 4.5 times greater for those with MH and SA conditions among both elderly men and women. Odds of a fall injury among elderly individuals with Alzheimer disease and other dementias are at least three times greater, and the differential increases with age. The increases in cost resulting from a fall injury are greater among both elderly men and women with MH conditions and Alzheimer disease and other dementias and among elderly women with SA conditions. CONCLUSION The substantial burden of fall injuries among the elderly with MH/SA conditions suggests the need to direct fall prevention and mitigation strategies specifically toward this vulnerable population.
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Sawka AM, Gafni A, Boulos P, Beattie K, Papaioannou A, Cranney A, Hanley DA, Adachi JD, Cheung A, Papadimitropoulos EA, Thabane L. 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 2007; 18:819-27. [PMID: 17221294 DOI: 10.1007/s00198-006-0307-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 11/22/2006] [Indexed: 10/23/2022]
Abstract
UNLABELLED 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 > or =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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Affiliation(s)
- A M Sawka
- Division of Endocrinology and Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
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Abstract
Falls are predominantly a problem of older people. In the UK, people over 65 currently account for around 60% of admissions and 70% of bed days in hospitals. There are approximately half a million older people in long-term care settings – many with frailty and multiple long-term conditions. The proportion of the population over 65 years is predicted to rise 25% by 2025, and that over 80 by 50%, with a similar increase in those with dependence for two or more activities of daily living. Despite policies to drive care to the community, it is likely that the proportion of older people in hospitals and care homes will therefore increase. Accidental falls are the commonest reported patient/resident safety incidents. Similar demographic trends can be seen in all developed nations, so that the growing problem of fall prevention in institutions is a global challenge. There has been far more focus in falls-prevention research on older people in ‘community’ settings, but falls are a pressing issue for hospitals and care homes, and a threat to the safety of patients and residents, even if a relatively small percentage of the population is in those settings at any one time.
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Honkanen LA, Mushlin AI, Lachs M, Schackman BR. Can Hip Protector Use Cost-Effectively Prevent Fractures in Community-Dwelling Geriatric Populations? J Am Geriatr Soc 2006; 54:1658-65. [PMID: 17087691 DOI: 10.1111/j.1532-5415.2006.00939.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To estimate the cost-effectiveness from a societal perspective of a hip protector (HP) program over the remaining lifetime of individuals initially living at home. DESIGN A state-transition Markov model considering outcomes of HP use in cohorts stratified by age, sex, and functional and residential status. Costs, transition probabilities, HP adherence, and efficacy were derived from published sources. SETTING Community and nursing homes in the United States. PARTICIPANTS Hypothetical cohort of individuals aged 65 and older without a hip fracture and initially living at home. INTERVENTION HP program. MEASUREMENTS Fractures, life years, and dollars saved, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER). RESULTS HP use prevented fractures and increased life expectancy in all cohorts. HP use saved costs and improved QALYs in women initiating HP use at age 80 and in men at age 85. In women initiating HP use at age 75, the HP ICER was 19,000 dollars/QALY. In men initiating HP use at age 80, HP use saved costs but slightly decreased QALYs. In younger cohorts, HP use was neither cost saving nor QALY improving. In sensitivity analyses, if there was no QALY loss from wearing a HP, the ICER was less than 50,000 dollars/QALY for all age and sex cohorts. If HP cost was reduced 50%, HP use was cost saving for women initiating HP use at age 75. In probabilistic sensitivity analyses, the HP ICER was less than 50,000 dollars/QALY in 68% of simulations for women initiating HP use at age 75 and 61% of simulations for men initiating at age 85. CONCLUSION HP use saved costs and QALYs for older age cohorts of both sexes. Additional research on the quality-of-life effects and obstacles to wearing HP is warranted.
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Affiliation(s)
- Lisa A Honkanen
- Division of Geriatrics and Gerontology, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Honkanen LA, Schackman BR, Mushlin AI, Lachs MS. RESPONSE TO COMMENTARY BY DR. OLIVER AND COLLEAGUES ON HIP PROTECTORS. J Am Geriatr Soc 2006; 54:1159-60. [PMID: 16866705 DOI: 10.1111/j.1532-5415.2006.00803.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ramroth H, Specht-Leible N, König HH, Brenner H. Hospitalizations during the last months of life of nursing home residents: a retrospective cohort study from Germany. BMC Health Serv Res 2006; 6:70. [PMID: 16762052 PMCID: PMC1524759 DOI: 10.1186/1472-6963-6-70] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 06/08/2006] [Indexed: 12/31/2022] Open
Abstract
Background To describe hospitalisations of nursing home (NH) residents in Germany during their last months of life. Methods Retrospective cohort study on 792 NH residents in the Rhine-Neckar region in South-West Germany, newly institutionalized in the year 2000, who died until the study end (December 2001). Baseline variables were derived from a standardized medical examination routinely conducted by the medical service of the health care insurance plans in Germany. Information on hospitalisations and deaths was extracted form records of the pertinent health insurance plans. Results NH residents who died after NH stay of more than 1 year spent 5.8% of their last year of life in hospitals. Relative time spent in hospitals increased from 5.2% twelve months before death (N = 139 persons) to 24.1% in their last week of life (N = 769 persons). No major differences could be observed concerning age, gender or duration of stay in NH. Overall, 229 persons (28.9%) died in hospital. Among these, the last hospital stay lasted less than 3 days for 76 persons (31.9%). Another 25 persons (3.2%) died within three days after hospital discharge. Conclusion Our study indicates that proximity of death is the most important driver of health care utilization among NH residents. The relation of age or gender to health care expenditures seem to be weak once time to death is controlled for. Duration of NH stay does not markedly change rates of hospitalisation during the last months of life.
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Affiliation(s)
- Heribert Ramroth
- German Centre for Research on Ageing, Heidelberg, Germany
- Department of Tropical Hygiene and Public Health, Heidelberg, Germany
| | - Norbert Specht-Leible
- Bethanien-Hospital, Geriatric Centre at the University Hospital, Heidelberg, Germany
| | - Hans-Helmut König
- Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - Hermann Brenner
- German Centre for Research on Ageing, Heidelberg, Germany
- Department of Clinical Epidemiology and Research on Ageing, German Cancer Research Center, Heidelberg, Germany
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Meyer G, Wegscheider K, Kersten JF, Icks A, Mühlhauser I. Increased Use of Hip Protectors in Nursing Homes: Economic Analysis of a Cluster Randomized, Controlled Trial. J Am Geriatr Soc 2005; 53:2153-8. [PMID: 16398901 DOI: 10.1111/j.1532-5415.2005.00490.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the cost-efficacy of an intervention program aimed at reducing hip fractures. DESIGN Economic evaluation within an 18-month cluster randomized trial. SETTING Forty-nine nursing homes in Hamburg, Germany. PARTICIPANTS Residents with a high risk of falling (intervention group (IG), n=459; control group (CG), n=483). INTERVENTION Education session for nurses, who subsequently educated residents, and provision of three hip protectors per resident. CG care was optimized by providing brief information to nurses about hip protectors and providing two protectors per nursing home for demonstration purposes. MEASUREMENTS Main outcomes were hip fractures, costs, and incremental cost-effectiveness ratio (ICER). RESULTS The intervention was effective in reducing hip fractures (21 in the IG vs 42 in the CG) and resulted in a cost difference of 51 dollars per participant in favor of the CG (95% confidence interval covering cost saving of 242 dollars to cost expense of 325 dollars). Costs per additional hip fracture avoided were 1,234 dollars. Sensitivity analyses aimed at investigating robustness of the results to a real practice implementation scenario resulted in ICERs varying from 439 dollars to 1,693 dollars. Taking into account lower hip protector reimbursement levels, the intervention program would be cost saving (break-even point within the base case analysis=22 dollars per hip protector). CONCLUSION A program consisting of education and provision of hip protectors might produce a slight increase in costs or might even be cost saving if the price of the hip protector could be decreased.
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Affiliation(s)
- Gabriele Meyer
- Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany.
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Oliver D, Connelly J, Allain T. ECONOMIC MODELING ON COST-EFFECTIVENESS OF HIP PROTECTORS IN INSTITUTIONALIZED OLDER PEOPLE BASED ON CONTENTIOUS INTERPRETATION OF ORIGINAL EFFECTIVENESS DATA. J Am Geriatr Soc 2005; 53:2241-2. [PMID: 16398924 DOI: 10.1111/j.1532-5415.2005.00512_9.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Injuries resulting from falls in elderly people are a major public-health concern, representing one of the main causes of longstanding pain, functional impairment, disability, and death in this population. The problem is going to worsen, since the rates of such injuries seem to be rising in many areas, as is the number of elderly people in both the developed and developing world. Many methods and programmes to prevent such injuries already exist, including regular exercise, vitamin D and calcium supplementation, withdrawal of psychotropic medication, cataract surgery, professional environment hazard assessment and modification, hip protectors, and multifactorial preventive programmes for simultaneous assessment and reduction of many of the predisposing and situational risk factors. To receive broader-scale effectiveness, these programmes will need systematic implementation. Care must be taken, however, to rigorously select the right actions for those people most likely to benefit, such as vitamin D and calcium supplementation and hip protectors for elderly people living in institutions.
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Affiliation(s)
- Pekka Kannus
- Accident & Trauma Research Centre, UKK Institute for Health Promotion Research, Tampere, Finland.
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Quereda F, Mendoza N, Olalla MA, Baró F, Durán M. Prophylactic approach for asymptomatic post-menopausal women: osteoporosis. Maturitas 2005; 52 Suppl 1:S38-45. [PMID: 16139446 DOI: 10.1016/j.maturitas.2005.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Accepted: 06/21/2005] [Indexed: 12/19/2022]
Abstract
To consider what a correct preventive approach for osteoporosis should be in the management of the asymptomatic post-menopausal woman. Literature review and opinions on this issue shared by a group of professionals with wide clinical experience in health care for peri- and post-menopausal women. There is agreement that osteoporosis combines most of the ideal requirements for the application of a preventive strategy. The natural evolution of this pathology leads to serious events, fractures, but it provides various opportunities for prevention. Osteoporosis can be avoided and in particular, fractures due to bone fragility and their consequences should be avoided. Nowadays, there are different courses of action (pharmacological or otherwise) with proven effectiveness for the prevention osteoporosis and osteoporotic fractures. However, long-term action is required for a broad segment of the population, so a certain strategy is necessary to guide clinical decisions for different profiles of women. There is little data in the literature to justify a different preventive approach, depending on the presence or absence of vasomotor symptoms, but clinical experience shows that their absence is not associated with a lower osteoporosis risk. Different strategies have been tried for the prevention of osteoporosis and its complications and some of them might be effective, but there is no analysis with conclusive results. A preventive strategy for osteoporosis should be included in the management of asymptomatic post-menopausal women, because this is an avoidable pathology and the absence of vasomotor symptoms does not reduce the risk of its development. Nevertheless, a well-designed cost-benefit analysis is needed to justify the implementation of any strategy at a community level, because adverse effects and economic cost could exceed the benefits obtained in low fracture risk populations.
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Affiliation(s)
- F Quereda
- Department of Obstetrics, San Juan University Hospital, Miguel Hernández University, Alicante, Spain.
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