Open Access

Background Hip fractures are a common and costly health problem, resulting in significant morbidity and mortality, as well as high costs for healthcare systems, especially for the elderly. Implementing surgical preventive strategies has the potential to improve the quality of life and reduce the burden on healthcare resources, particularly in the long term. However, there are currently limited guidelines for standardizing hip fracture prophylaxis practices. Methods This study used a cost-effectiveness analysis with a finite-state Markov model and cohort simulation to evaluate the primary and secondary surgical prevention of hip fractures in the elderly. Patients aged 60 to 90 years were simulated in two different models (A and B) to assess prevention at different levels. Model A assumed prophylaxis was performed during the fracture operation on the contralateral side, while Model B included individuals with high fracture risk factors. Costs were obtained from the Centers for Medicare & Medicaid Services, and transition probabilities and health state utilities were derived from available literature. The baseline assumption was a 10% reduction in fracture risk after prophylaxis. A sensitivity analysis was also conducted to assess the reliability and variability of the results. Results With a 10% fracture risk reduction, model A costs between $8,850 and $46,940 per quality-adjusted life-year ($/QALY). Additionally, it proved most cost-effective in the age range between 61 and 81 years. The sensitivity analysis established that a reduction of ≥ 2.8% is needed for prophylaxis to be definitely cost-effective. The cost-effectiveness at the secondary prevention level was most sensitive to the cost of the contralateral side’s prophylaxis, the patient’s age, and fracture treatment cost. For high-risk patients with no fracture history, the cost-effectiveness of a preventive strategy depends on their risk profile. In the baseline analysis, the incremental cost-effectiveness ratio at the primary prevention level varied between $11,000/QALY and $74,000/QALY, which is below the defined willingness to pay threshold. Conclusion Due to the high cost of hip fracture treatment and its increased morbidity, surgical prophylaxis strategies have demonstrated that they can significantly relieve the healthcare system. Various key assumptions facilitated the modeling, allowing for adequate room for uncertainty. Further research is needed to evaluate health-state-associated risks.

Obstacle avoidance is critical for unmanned aerial vehicles (UAVs) operating autonomously. Obstacle avoidance algorithms either rely on global environment data or local sensor data. Local path planners react to unforeseen objects and plan purely on local sensor information. Similarly, animals need to find feasible paths based on local information about their surroundings. Therefore, their behavior is a valuable source of inspiration for path planning. Bumblebees tend to fly vertically over far-away obstacles and horizontally around close ones, implying two zones for different flight strategies depending on the distance to obstacles. This work enhances the local path planner 3DVFH* with this bio-inspired strategy. The algorithm alters the goal-driven function of the 3DVFH* to climb-preferring if obstacles are far away. Prior experiments with bumblebees led to two definitions of flight zone limits depending on the distance to obstacles, leading to two algorithm variants. Both variants reduce the probability of not reaching the goal of a 3DVFH* implementation in Matlab/Simulink. The best variant, 3DVFH*b-b, reduces this probability from 70.7 to 18.6% in city-like worlds using a strong vertical evasion strategy. Energy consumption is higher, and flight paths are longer compared to the algorithm version with pronounced horizontal evasion tendency. A parameter study analyzes the effect of different weighting factors in the cost function. The best parameter combination shows a failure probability of 6.9% in city-like worlds and reduces energy consumption by 28%. Our findings demonstrate the potential of bio-inspired approaches for improving the performance of local path planning algorithms for UAV.