OBJECTIVES: Fall-related hip fractures in elderly people are associated with high burden for the persons concerned and for the general public. Clinical studies showed that a specific strength-and-balance training may prevent fractures. In this modeling study, we evaluated the cost-effectiveness of an exercise program provided to elderly still living at home (with no prevention as a comparator).

METHODS: We developed a literature-based Markov model with a lifetime horizon from the perspective of the German statutory health insurance (SHI). Input data were obtained from the literature and from public statistics. An incremental cost-effectiveness ratio (ICER) was calculated with results presented as costs per hip fracture avoided. To assess the parameter uncertainty, deterministic and probabilistic sensitivity analyzes were performed. The monetary consequences for the SHI were estimated in a budget impact analysis (BIA).

RESULTS: For women, the specific strength-balance training resulted in an ICER of €32,100 per hip fracture avoided (male cohort: € 57,100). Costs for the SHI are expected to amount to € 1.8 million (women) and € 3.5 million (men), respectively. Sensitivity analyses confirmed the robustness of the results.

CONCLUSIONS: The findings of our modeling study indicate that in women the intervention results in a moderate cost-effectiveness ratio and acceptable additional costs for the SHI. Due to the shorter life expectancy of the male cohort compared to the female cohort, the strength-and-balance training is not cost-effective for elderly men.