title: Cost-effectiveness of a multifactorial fracture prevention program for elderly people admitted to nursing homes.
abstract: BACKGROUND
  Fractures are one of the most costly consequences of falls in elderly patients in nursing homes.
  
  
  OBJECTIVE
  To compare the cost-effectiveness of a 'multifactorial fracture prevention program' provided by a multidisciplinary team with 'no prevention' in newly admitted nursing home residents.
  
  
  METHODS
  We performed a cost-utility analysis using a Markov-based simulation model to establish the effectiveness of a multifaceted fall prevention program from the perspective of statutory health insurance (SHI) and long-term care insurance (LCI). The rate of falls was used to estimate the clinical and economic consequences resulting from hip and upper limb fractures. Robustness of the results was assessed using deterministic and probabilistic sensitivity analyses.
  
  
  RESULTS
  Compared to no prevention a multifactorial prevention program for nursing home residents resulted in a cost-effectiveness ratio of 21,353 euro per quality-adjusted life-year. The total costs for SHI/LCI would result in 1.7 euro million per year. Results proved to be robust following deterministic and probabilistic sensitivity analyses.
  
  
  CONCLUSIONS
  Multifactorial fracture prevention appears to be cost-effective in preventing fractures in nursing home residents. Since the results were based on the number of falls further research is required to confirm the results.
authors.affiliation: Cologne Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Cologne, Germany, dirk.mueller@uk-koeln.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Müller
authors.forename: Lisa
authors.initials: L
authors.lastname: Borsi
authors.forename: Claudia
authors.initials: C
authors.lastname: Stracke
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stock
authors.forename: Björn
authors.initials: B
authors.lastname: Stollenwerk
mesh_terms: D000058:Accidental Falls / Q000191:economics / Q000517:prevention & control; D000369:Aged, 80 and over; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D050723:Fractures, Bone / Q000191:economics* / Q000517:prevention & control*; D015577:Geriatric Assessment; D005858:Germany; D006620:Hip Fractures; D006707:Homes for the Aged / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008390:Markov Chains; D017059:Models, Econometric; D009735:Nursing Homes / Q000191:economics / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000191:economics* / Q000458:organization & administration*; D019057:Quality-Adjusted Life Years; D034941:Upper Extremity