The Cost-Effectiveness Of Implementing An Exercise Program For Fall And Fracture Prevention In Adults Aged 65 And Older On Proton Pump Inhibitor Therapy

INTRODUCTION: National guidelines recommend implementing an exercise program in community-dwelling adults ≥ 65 years old to decrease risk of falling. Proton pump inhibitors (PPI) are not currently recognized as contributing risk factors for falls in these guidelines. However, observational studies have linked PPI use with increased falls and fractures. In 2013, 7,000,000 people over the age of 65 were using PPIs. We studied the economic effects of fall prevention programs in PPI users over 65 and hypothesize that these programs will produce significant healthcare savings. METHODS: Using previously published data, we developed a cost-benefit model to predict various outcomes associated with a fall and fracture in the elderly (Figure 1). We incorporated three exercise programs: Tai Chi, Stepping On, and the Otago. We conducted sensitivity analysis using different Odds Ratios (OR)s for falls in PPI users to determine the threshold of effectiveness of the interventions. We then compared the average cost of each program to the relative reduction in cost associated with a fall and fracture to determine the financial benefit to elderly patients taking PPI therapy. RESULTS: Based on prior studies, adults over 65 have a 30% chance of falling annually with a 33.4% likelihood of seeking medical care. Sensitivity analysis was performed for OR for PPI use and falling ranging from 1.2 to 3.77 (P-value = 0.05). The annual expected cost of falls and fractures in adults over 65 on PPI therapy ranged from $10,317.35 to $18,766.28. Cost of the exercise programs ranged from $112.70 to $336.82 annually, with an anticipated fall reduction ranging from 31-55% based on the literature. Using a range of ORs for PPI use and fall/fracture rate, the model suggests a net financial benefit when reduction of falls is greater than 5% (Figure 3). Individual benefits achieved from exercise programs ranged from $3,198.38 to $10,208.76 (Figure 2). The annual net financial benefit of these programs in the US population of PPI users over age 65 ranges from $18 to $85 billion in savings (Figure 3). CONCLUSION: With modest fall reduction returns above 5%, implementing a fall prevention exercise program in patients over 65 on PPI therapy offers an effective means of reducing the overall financial impact of falls and fractures both individually and on a national level. Formal exercise programs including Tai Chi, Stepping On, and the Otago are highly recommended for these patients.Figure 1.: This figure illustrates our financial model of the costs attributable to falling in a population of PPI users over age 65.Figure 2.: This figure represents the average annual financial benefit of implementing one of three exercise programs to reduce fall and fracture risk in elderly patients over the age of 65 in comparison between PPI and non-PPI users.Figure 3.: This figure represents sensitivity analysis conducted on different odds ratios (OR) between PPI and falling rate. For all OR’s, there was an expected annual benefit when the exercise program implemented conferred a fall reduction greater than 5%.