Impact of hip fracture on hospital care costs: a population-based study

J Leal, A M Gray, D Prieto-Alhambra, N K Arden, C Cooper, M K Javaid, A Judge, REFReSH study group, J Leal, A M Gray, D Prieto-Alhambra, N K Arden, C Cooper, M K Javaid, A Judge, REFReSH study group

Abstract

Using a large cohort of hip fracture patients, we estimated hospital costs to be £14,163 and £2139 in the first and second year following fracture, respectively. Second hip and non-hip fractures were major cost drivers. There is a strong economic incentive to identify cost-effective approaches for hip fracture prevention.

Introduction: The purpose of this study was to estimate hospital costs of hip fracture up to 2 years post-fracture and compare costs before and after the index fracture.

Methods: A cohort of patients aged over 60 years admitted with a hip fracture in a UK region between 2003 and 2013 were identified from hospital records and followed until death or administrative censoring. All hospital records were valued using 2012/2013 unit costs, and non-parametric censoring methods were used to adjust for censoring when estimating average annual costs. A generalised linear model examined the main predictors of hospital costs.

Results: A cohort of 33,152 patients with a hip fracture was identified (mean age 83 years (SD 8.2). The mean censor-adjusted 1- and 2-year hospital costs after index hip fracture were £14,163 (95 % confidence interval (CI) £14,008 to £14,317) and £16,302 (95 % CI £16,097 to £16,515), respectively. Index admission accounted for 61 % (£8613; 95 % CI £8565 to £8661) of total 1-year hospital costs which were £10,964 higher compared to the year pre-event (p < 0.001). The main predictors of 1-year hospital costs were second hip fracture, other non-hip fragility fractures requiring hospitalisation and hip fracture-related complications. Total UK annual hospital costs associated with incident hip fractures were estimated at £1.1 billion.

Conclusions: Hospital costs following hip fracture are high and mostly occur in the first year after the index hip fracture. Experiencing a second hip fracture after the index fracture accounted for much of the increase in costs. There is a strong economic incentive to prioritise research funds towards identifying the best approaches to prevent both index and subsequent hip fractures.

Keywords: Burden; Cost; Epidemiology; Health economics; Hip fracture; Osteoporosis.

Figures

Fig. 1
Fig. 1
Hospitalisation costs in the months before and after primary hip fracture. Legend: *Complete cases, including those who died in that year

References

    1. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17:1726–1733. doi: 10.1007/s00198-006-0172-4.
    1. Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA) Arch Osteoporos. 2013;8:136. doi: 10.1007/s11657-013-0136-1.
    1. Burge RT, Worley D, Johansen A, Bhattacharyya S, Bose U. The cost of osteoporotic fractures in the UK: projections for 2000–2020. J Med Econ. 2001;4:51–62. doi: 10.3111/200104051062.
    1. Stevenson MD, Davis SE, Kanis JA. The hospitalisation costs and out-patient costs of fragility fractures. Women's Health Med. 2006;3:149–151. doi: 10.1383/wohm.2006.3.4.149.
    1. Dolan P, Torgerson DJ. The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporos Int. 1998;8:611–617. doi: 10.1007/s001980050107.
    1. National Institute for Health and Care Excellence (2011) Hip fracture: the management of hip fracture in adults. NICE guidelines CG124.
    1. Drew S, Sheard S, Chana J, Cooper C, Javaid MK, Judge A. Describing variation in the delivery of secondary fracture prevention after hip fracture: an overview of 11 hospitals within one regional area in England. Osteoporos Int. 2014;25:2427–2433. doi: 10.1007/s00198-014-2775-5.
    1. Health & Social Care Information Centre (2014) Methodology to create provider and cip spells from HES APC data.
    1. Health & Social Care Information Centre (2013) Casemix Grouper.
    1. Department of Health (2013) NHS reference costs 2012 to 2013.
    1. Lin DY. Linear regression analysis of censored medical costs. Biostatistics. 2000;1:35–47. doi: 10.1093/biostatistics/1.1.35.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383. doi: 10.1016/0021-9681(87)90171-8.
    1. National Joint Registry (2013) OPCS codes relevant to procedures recorded in the NJR. Version 3.
    1. Iglesias CP, Manca A, Torgerson DJ. The health-related quality of life and cost implications of falls in elderly women. Osteoporos Int. 2009;20:869–878. doi: 10.1007/s00198-008-0753-5.
    1. Gutiérrez L, Roskell N, Castellsague J, Beard S, Rycroft C, Abeysinghe S, Shannon P, Robbins S, Gitlin M. Study of the incremental cost and clinical burden of hip fractures in postmenopausal women in the United Kingdom. J Med Econ. 2011;14:99–107. doi: 10.3111/13696998.2010.547967.
    1. Kazi HA, Acharya A. Comparison of trauma and elective income in a district general hospital. BJMP. 2011;4:a440.
    1. Lawrence TM, White CT, Wenn R, Moran CG. The current hospital costs of treating hip fractures. Injury. 2005;36:88–91. doi: 10.1016/j.injury.2004.06.015.
    1. Sahota O, Morgan N, Moran CG. The direct cost of acute hip fracture care in care home residents in the UK. Osteoporos Int. 2012;23:917–920. doi: 10.1007/s00198-011-1651-9.
    1. Thakar C, Alsousou J, Hamilton TW, Willett K. The cost and consequences of proximal femoral fractures which require further surgery following initial fixation. J Bone Joint Surg Br Vol. 2010;92-B:1669–1677. doi: 10.1302/0301-620X.92B12.25021.
    1. Lambrelli D, Burge R, Raluy-Callado M, Chen SY, Wu N, Schoenfeld MJ. Retrospective database study to assess the economic impact of hip fracture in the United Kingdom. J Med Econ. 2014;17:817–825. doi: 10.3111/13696998.2014.959588.
    1. National Hip Fracture Database (2013) National report 2013.
    1. Luengo-Fernandez R, Gray AM, Rothwell PM, Oxford Vascular S. A population-based study of hospital care costs during 5 years after transient ischemic attack and stroke. Stroke. 2012;43:3343–3351. doi: 10.1161/STROKEAHA.112.667204.
    1. Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ. Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int. 2013;24:393–406. doi: 10.1007/s00198-012-2090-y.
    1. Mitchell PJ. Fracture Liaison Services: the UK experience. Osteoporos Int. 2011;22:487–494. doi: 10.1007/s00198-011-1702-2.
    1. McLellan AR, Wolowacz SE, Zimovetz EA, Beard SM, Lock S, McCrink L, Adekunle F, Roberts D. Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int. 2011;22:2083–2098. doi: 10.1007/s00198-011-1534-0.
    1. Ioannidis G, Flahive J, Pickard L, et al. Non-hip, non-spine fractures drive healthcare utilization following a fracture: the Global Longitudinal Study of Osteoporosis in Women (GLOW) Osteoporos Int. 2013;24:59–67. doi: 10.1007/s00198-012-1968-z.
    1. Hansen L, Mathiesen AS, Vestergaard P, Ehlers LH, Petersen KD. A health economic analysis of osteoporotic fractures: who carries the burden? Arch Osteoporos. 2013;8:126. doi: 10.1007/s11657-013-0126-3.
    1. Eisman JA, Bogoch ER, Dell R, et al. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res. 2012;27:2039–2046. doi: 10.1002/jbmr.1698.
    1. Marsh D, Akesson K, Beaton DE, et al. Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int. 2011;22:2051–2065. doi: 10.1007/s00198-011-1642-x.
    1. National Institute for Health and Care Excellence (2008) Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. NICE technology appraisal guidance TA161.
    1. Åkesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C. Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013;24:2135–2152. doi: 10.1007/s00198-013-2348-z.
    1. Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20:1633–1650. doi: 10.1007/s00198-009-0920-3.
    1. Neuburger J, Currie C, Wakeman R, Tsang C, Plant F, De Stavola B, Cromwell DA, van der Meulen J. The impact of a national clinician-led audit initiative on care and mortality after hip fracture in England: an external evaluation using time trends in non-audit data. Med Care. 2015;53:686–691. doi: 10.1097/MLR.0000000000000383.

Source: PubMed

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