Hip fractures are the single biggest cause of hospital bed occupancy in Denmark. The total for hip fractures in Denmark is now about 7,500 cases per year. Over 90% of all hip fractures are caused by falls. The risk of a fall and therefore of a fracture increases with age, and the average age of patients with hip fractures is over 80. The majority of hip fracture patients have one or more simultaneous chronic medical conditions.
Hip fractures therefore particularly affect residents with a previous invalidity, and so a fracture often has serious consequences. If falls can be prevented from resulting in fractures, the risk of both invalidity and mortality can presumably be significantly reduced, and at the same time it will be possible to reduce the number of casualty ward contacts, bed days on admission and rehabilitation courses.
A hip protector can reduce the impact of a fall onto the hip, and thereby reduce the risk of hip fractures amongst elderly and frail people who are at a high risk of falling. The effectiveness of hip protectors in the prevention of hip fractures amongst residents of nursing homes was investigated in the Canadian MTA report "Hip Protectors in Long-Term Care: A Clinical and Cost-Effectiveness Review and Primary Economic Evaluation" (the CADTH report) of
2008. The purpose of this commentary is to carry out a critical evaluation of the CADTH report and its recommendations, and to determine to what degree the conclusions can be applied in a Danish context.
The CADTH report is based in part on a systematic review of literature from January
2003 to March 2008, and partly on an original decision-analytical cost-effectiveness model. This commentary has been added to by an updated search for literature that has been expanded from March 2008 to October 2009, based on the search strategy of the CADTH report.
The authors of the CADTH report recommend that hip protection be included when considering programmes intended to prevent falls amongst residents of nursing homes. Those who would benefit most from the use of hip protectors are elderly residents of nursing homes with a high risk of falling. The conclusion of the financial model analysis is that combined use of hip protectors and alendronate in 75 to 89-year-old women living in nursing homes is cost-effective at a maximum willingness-to-pay of CAD 50,000 per QALY (» DKK
237,000). The authors also conclude that if the choice is between no prevention and isolated use of hip protectors, then the use of hip protectors is cost-effective at the same maximum willingness-to-pay.
Conclusion for Danish practice
Based on the commentary, the authors of this Annotated Foreign MTA conclude that there is support for the fact that the use of hip protectors is both clinically effective and cost-effective in the prevention of hip fractures amongst elderly residents of Danish nursing homes at a high risk of falling. The effect of the intervention is dependent on supporting procedures being in place and on the training of health professionals. It is also of decisive importance that individual residents be involved in trying out hip protection and deciding on its use in order to ensure good compliance.