Potential cost of falls with Stroke patients

Patients who have had a stroke are at high risk of falling. In a study by Tutarrima(1) et al. the incidence of falls was 8.9 / 1000 per day. They found that 25% of falls lead to injury which ranged from slight to severe while 2% of falls resulted in hip fractures. These injuries obviously have a significant impact on the health service. In a separate study, Rizzo(2) et al. showed that the impact of an average fall in the USA was $11,042 to the hospital while home nursing costs were $5,325 leading to a total cost of $19,440 (1996 prices). This does not include the impact on employment or on family members who have extra burden placed on them. While there is no objective direct evidence that use of a dropped foot stimulator reduces falls, Taylor(3) et al found in a questionnaire survey of users of the Odstock Dropped Foot Stimulator that 70% of uses claimed that they used the device because they were less likely to trip. This is backed up by the observation by Granat(4) et al. that foot to floor contact was more reliable, correcting lateral border of the foot weight bearing in the early stance phase. This will lead to more stable gait, resulting in a reduced incidence of falls and a significant impact on costs to the NHS.

Potential cost saving to the NHS by reducing the number of falls

In order to calculate the cost benefit for the ODFS, values quoted in references 1-4 have been used:

Without any aid, 89/ 1000 patients have a fall each day, hence each patient falls 3.2 times per year. However, only 25% of these result in injury, which means that each patient injures themselves 0.8 times per year. An average cost to the NHS per fall is £13,000 (assuming the same cost as in the USA). Hence the total cost per patient per year is £10,368.

However, as the original fall data was from patients who were receiving inpatient rehabilitation following their stroke it is reasonable to assume that after that period falls would occur less frequently. Also not all patients would benefit from the device. Therefore the fall rate may be assumed to be one quarter of that stated leading to on average, one fall in which an injury occurs being experience once every five years. The cost per year would therefore be £2,592. This includes home care costs, which are not covered by the NHS. Excluding these the costs to the NHS will be approximately £1,472, or £1766 allowing for 20% inflation since 1996, which is 1.76 times the first year costs of the ODFS.

Therefore, it can be concluded on this analysis alone that the cost to the NHS in supplying stroke patients with the ODFS will be recovered in less than 8 months. After that there is significant financial benefit to the NHS of around £1,566 per year.

1. Tutuarima JA, van der Meulen JHP, de HaanRJ, Limburg M. (1997) Risk factors for falls of hospitalized stroke patients. Stroke 28(2):297-301, 1997 FEB

2. Rizzo JA, Friedkin R, Williams CS Nabors J, Acampora D Tinetti ME. Health care utilization and cost in a Medicare population by fall status. Medical Care 36(8):1174-88, 1998 Aug.

3. Taylor PN, Burridge JH, Dunkerley AL , Lamb A, Wood DE, Norton JA, Swain ID. Patient's Perceptions of the Odstock Dropped Foot Stimulator (ODFS). Clin. Rehab. 1999; 13: 333-340

4. Granat MH, Maxwell DJ, Fergusen ACB, Lees KR, Barbanel JC. Evaluation of common peroneal stimulation for the correction of dropped foot in hemiplegia. Archives of Physical Medicine and Rehabilitation. 1996;77:19-24

Paul Taylor