Archives of Osteoporosis

, 13:122 | Cite as

Cost-effectiveness of a home safety intervention to prevent falls in impaired elderly people living in the community

  • Christopher Kunigkeit
  • Stephanie Stock
  • Dirk MüllerEmail author
Original Article



Among others, the German National Prevention Conference recently recommended the provision of preventive options for elderly to maintain their independent living. Because a home safety assessment and modification program (HSM) has shown to be effective in avoiding falls and risk of falling in elderly, the aim of this analysis was to evaluate the cost-effectiveness of HSM in patients aged ≥ 80 years who receive non-institutionalized long-term care.


In order to reflect quality-adjusted life years (QALYs) and costs resulting from HSM, a Markov-model with a time horizon of 20 years was performed from the perspective of the German statutory health insurance (SHI) and statutory long-term care insurance (LCI). The model assumed that HSM reduces fall-related hip fractures in accordance with the reduction of the rate of falls. Data was obtained from public databases and from various literature searches. The robustness of the results was assessed in deterministic and probabilistic sensitivity analyses.


In women, the incremental cost-effectiveness ratio of HSM compared to no prevention was €9580 per QALY, while in men, it was €57,589. For the German SHI/LCI, in total, the provision of HSM to patients ≥ 80 years who receive non-institutionalized long-term care would result in annual costs of €7.7 million. The results were robust in several sensitivity analyses.


Provided that the rate of falls is a valid surrogate endpoint for the rate of fall-related hip fractures, HSM could be a promising approach for investments in preventive options targeting the reduction of fall-related fractures in elderly women.


Cost-effectiveness Prevention of falls Hip fracture Modeling 

Supplementary material

11657_2018_535_MOESM1_ESM.docx (207 kb)
ESM 1 (DOCX 206 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Christopher Kunigkeit
    • 1
  • Stephanie Stock
    • 1
  • Dirk Müller
    • 1
    Email author
  1. 1.Institute for Health Economics and Clinical EpidemiologyThe University Hospital of Cologne (AöR)CologneGermany

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