Cost-effectiveness of a multifactorial fracture prevention program for elderly people admitted to nursing homes

Background: Fractures are one of the most costly consequences of falls in elderly patients who admitted to nursing homes. Objectives: To compare the cost-effectiveness of a multifactorial fracture prevention provided by a multidisciplinary team with no prevention in newly admitted nursing home residents. Methods: Using the rate of falls as a proxy for hip and upper limb fractures, a cost-utility analysis was performed from the perspective of the statutory health insurance and long-term care insurance funds (SHI/LCI). A Markov-model with a lifelong time horizon was developed. Robustness of the results were assessed in deterministic and probabilistic sensitivity analyses. Results: Multifactorial prevention in nursing home residents dominates the no prevention strategy. The provision of a prevention program for newly admitted residents resulted in cost savings of €229 per treated patient with additional QALYs of 0.0128. The results were robust in deterministic and probabilistic sensitivity analyses. Conclusion: Multifactorial fracture prevention appears to be highly cost-effective to prevent fractures in nursing home residents. Since the number of fractures were based on the number of falls as a proxy, the results should be considered with caution.

cost-effectiveness - elderly people - modeling - multifactorial - nursing homes - prevention