Department of Medical Sociology and Health Economics, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Osteoporos Int. 2013 Apr;24(4):1215-23. doi: 10.1007/s00198-012-2075-x. Epub 2012 Jul 18.
The purpose of this study was to analyze the cost-effectiveness of a multifactorial fall prevention program in nursing home residents. Given a willingness-to-pay (WTP) of 50,000 EUR per year free of femoral fracture, the probability that the intervention is cost-effective is 83%.
Despite their increased risk of falls and fractures, nursing home residents have been neglected in economic evaluations of fall prevention programs so far. The purpose of this study was to analyze, for the first time, the cost-effectiveness of a multifactorial fall prevention program in nursing home residents.
This study is part of a prospective, unblinded, cluster, nonrandomized, controlled study focusing on the transfer of an efficacious fall prevention program into a real-world setting. The analyzed subsample was derived from claims data and consisted of data on intervention (n=256, residents n=10,178) and control homes (n=893, residents n=22,974), representing all insurants of a sickness fund (AOK Bavaria, Germany) who were 65 years or older, residing in a nursing home on the 31st of March 2007 and had a level of care of ≥1 according to the classification of the statutory long-term care insurance. Time free of femoral fracture (ICD-10, S72) was used as measure of health effects. Femoral fracture-related costs and intervention costs were measured from a payer perspective. Multivariate regression models were applied. Sensitivity analyses were performed and cost-effectiveness acceptability curves computed.
Within the first year of the intervention, femoral fracture rate was significantly reduced, resulting in a nonsignificant incremental mean time of 1.41 days free of femoral fracture. Incremental mean total direct costs were 29 EUR per resident, which was not significant. The incremental cost-effectiveness ratio (ICER) was 7,481 EUR per year free of femoral fracture. The probability of an ICER<50,000 EUR per year free of femoral fracture was 83%.
Depending on the amount the decision-maker is willing to pay for the incremental effect, the fall prevention program might be cost-effective within the first year. Future studies should expand the range of costs and effects measured.
本研究旨在分析疗养院居民多因素防跌倒计划的成本效益。若决策者愿意每年支付 50000 欧元来避免股骨骨折，那么该干预措施具有成本效益的概率为 83%。
尽管疗养院居民跌倒和骨折的风险增加，但迄今为止，他们在经济评估防跌倒计划中一直被忽视。本研究首次分析了疗养院居民多因素防跌倒计划的成本效益。
本研究是一项前瞻性、非盲、集群、非随机、对照研究的一部分，重点是将有效的防跌倒计划转移到实际环境中。分析的样本来自索赔数据，包括干预组（n=256，居民 n=10178）和对照组（n=893，居民 n=22974）的数据，代表德国 AOK 巴伐利亚（AOK Bavaria）健康保险的所有被保险人，年龄在 65 岁或以上，2007 年 3 月 31 日居住在疗养院，护理级别≥1，根据法定长期护理保险的分类。无股骨骨折时间（ICD-10，S72）被用作健康效果的衡量标准。从支付者的角度衡量股骨骨折相关成本和干预成本。应用多元回归模型。进行敏感性分析并计算成本效益可接受性曲线。
在干预的第一年，股骨骨折发生率显著降低，导致无股骨骨折的平均时间增加 1.41 天，但无统计学意义。居民人均增量总成本为 29 欧元，无统计学意义。增量成本效益比（ICER）为每年每避免股骨骨折 7481 欧元。ICER<50000 欧元/年避免股骨骨折的概率为 83%。
根据决策者愿意为增量效果支付的金额，该防跌倒计划在第一年可能具有成本效益。未来的研究应扩大所测量的成本和效果范围。
