Abstract
BackgroundElderly injuries are a recognized public health concern and are due to two factors; osteoporosis and accidental falls. Several osteoporosis pharmaceuticals are considered cost-effective, but intervention programs aiming at preventing falls should also be subjected to economic evaluations. This study presents a cost-effectiveness analysis of a community-based elderly safety promotion program.MethodsA five-year elderly safety promotion program combining environmental structural changes with individually based measures was implemented in a community in the metropolitan area of Stockholm, Sweden. The community had around 5,500 inhabitants aged 65+ years and a first hip fracture incidence of 10.7 per 1,000 in pre-intervention years 1990–1995. The intervention outcome was measured as avoided hip fractures, obtained from a register-based quasi-experimental longitudinal analysis with several control areas. The long-term consequences in societal costs and health effects due to the avoided hip fractures, conservatively assumed to be avoided for one year, were estimated with a Markov model based on Swedish data. The analysis holds the societal perspective and conforms to recommendations for pharmaceutical cost-effectiveness analyses.ResultsTotal societal intervention costs amounted to 6.45 million SEK (in Swedish krona 2004; 1 Euro = 9.13 SEK). The number of avoided hip fractures during the six-year post-intervention period was estimated to 14 (0.44 per 1,000 person-years). The Markov model estimated a difference in societal costs between an individual that experiences a first year hip fracture and an individual that avoids a first year hip fracture ranging from 280,000 to 550,000 SEK, and between 1.1 and 3.2 QALYs (quality-adjusted life-years, discounted 3%), for males and females aged 65–79 years and 80+ years. The cost-effectiveness analysis resulted in zero net costs and a gain of 35 QALYs, and the do-nothing alternative was thus dominated.ConclusionThe community-based elderly safety promotion program aiming at preventing accidental falls seems as cost-effective as osteoporosis pharmaceuticals.
Highlights
Injuries are a recognized public health concern and are due to two factors; osteoporosis and accidental falls
It is unlikely that the high number during one year is due to the intervention, but instead of adjusting the figure, e.g. by replacing it with the average number during the period, we conservatively concluded that the intervention had not had any effect among the elderly women
These 14 avoided hip fractures, assuming they were avoided for one year and the individuals run the risk of contracting a hip fracture during subsequent years, result in zero net costs and an increase in health of 35 QALYs, in comparison with a do-nothing alternative
Summary
Injuries are a recognized public health concern and are due to two factors; osteoporosis and accidental falls. In particular hip fractures, constitute a considerable public health problem, in countries with an aging population. The risk for a woman aged 50 years to suffer from a hip fracture during her remaining lifetime is reported to exceed 15% in ten countries (of 22 investigated). The high incidence involves high costs, amounting to approximately 0.6% of the total health care costs in eight countries investigated during the 1990s [2]. The incidence in Sweden is among the highest in the world, with a remaining risk of nearly 30% for a 50-year old women and 13% for a man [1], with costs amounting to 2–3% of the total health care costs [2,3]. Several pharmaceuticals have been deemed cost-effective by the Swedish Pharmaceutical Benefits Board (LFN), and are subsidized by the drug benefit system
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