Hip protectors are cost-effective in the prevention of hip fractures in patients with high fracture risk

de Bot, R. T. A. L.; Veldman, H. D.; Witlox, A. M.; van Rhijn, L. W.; Hiligsmann, M.

Affiliations

¹Department of Orthopaedics, Maastricht University Medical Center, Maastricht, The Netherlands

²Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands

³Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center Heerlen, Heerlen, The Netherlands

Abstract and keywords

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.

Keywords: Cost-effectiveness; Hip fractures; Hip protectors; Osteoporosis

Links

DOI: 10.1007/s00198-019-05252-8

PubMed: 32040600

WoS: 000516097600002

History

Received: 2019-09-05

Accepted: 2019-11-29

Online: 2020-02-10

Cited Works (16)

Year	Entry
1993	Lauritzen JB, Petersen MM, Lund B. Effect of external hip protectors on hip fractures. Lancet. January 2, 1993;341(8836):11-13.
2003	Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. March 2003;51(3):364-370.
1992	Riggs BL, Melton LJ III. The prevention and treatment of osteoporosis. NEJM. August 27, 1992;327(9):620-627.
2009	Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. July 21, 2009;6(7):e1000097.
2012	Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database Sys Rev. 2012;9:CD007146.
1992	Johnell O, Gullberg B, Allander E, Kanis JA; MEDOS Study Group. The apparent incidence of hip fracture in europe: a study of national register sources. Osteoporos Int. November 1992;2(6):298-302.
2013	Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA. Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos. December 2013;8(1):136.
1985	Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985;7:178-208.
2007	Burge R, Dawson‐Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis‐related fractures in the United States, 2005–2025. J Bone Miner Res. March 2007;22(3):465-475.
2002	Cummings SR, Melton LJ III. Epidemiology and outcomes of osteoporotic fractures. Lancet. May 18, 2002;359(9319):1761-1767.
1995	Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM; Study of Osteoporotic Fractures Research Group. Risk factors for hip fracture in white women. NEJM. March 23, 1995;332(12):767-773.
1991	Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O'Brien LA, Hoffman S, Kaplan F; Northeast Hip Fracture Study Group. Risk factors for falls as a cause of hip fracture in women. NEJM. May 9, 1991;324(19):1326-1331.
2011	Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Sys Rev. July 6, 2011;7:CD000333.
1996	Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. May 18, 1996;312(7041):1254-1259.
2010	Haentjens P, Magaziner J, Colón-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. March 16, 2010;152(6):380-390.
1992	Cooper C, Campion G, Melton LJ III. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. November 1992;2(6):285-289.