Analytical approach:
: A state-transition Markov model was used to combine the cost and effectiveness data from the literature. The time horizon was the remaining life expectancy of a cohort of 79-year-old women. The authors did not report the study perspective.
Effectiveness data:
The effectiveness data were mainly from a selection of published studies. The relative risks of hip fractures with hip pad protectors and with prophylactic fixation strategies, and the age- and sex-specific risks of a contralateral hip fracture were from a published meta-analysis. The mortality estimates were from the 2001 US life tables. The main effectiveness parameter was the number of hip fractures and complications related to hip fracture.
Monetary benefit and utility valuations:
The utility values were age and sex specific and were from the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey, Household component, for the US population. These values were estimated using the European Quality of life (EQ-5D) questionnaire. The disutilities were estimated from the published literature and clinical judgement, and were then subtracted from the utility values.
Measure of benefit:
The primary measure of benefit was the number of quality-adjusted life-years (QALYs) gained. These were discounted at 3% per annum.
Cost data:
The direct medical cost categories were the costs of surgery, treatment, and rehabilitation and those costs associated with complications. The cost estimates were from a number of published sources. Some operating costs were from the authors’ institution and clinical judgement. The costs were presented in 2006 US dollars ($) and, where they were inflated, the medical care component of the consumer price index was used. They were discounted at 3% per annum.
Analysis of uncertainty:
One-way and two-way sensitivity analyses were performed to assess the impact of parameter uncertainty on the results. The results of the sensitivity analyses were presented in bar and line graphs.