Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study

P T P W Burgers, M Hoogendoorn, E A C Van Woensel, R W Poolman, M Bhandari, P Patka, E M M Van Lieshout, HEALTH Trial Investigators

Abstract

The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost awareness.

Introduction: The absolute number of hip fractures is rising and increases the already significant burden on society. The aim of this study was to determine the mean total medical costs per patient for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients.

Methods: The population was the Dutch sample of an international randomized controlled trial consisting of femoral neck fracture patients treated with hemi- or total hip arthroplasty. Patient data and health care utilization were prospectively collected during a total follow-up period of 2 years. Costs were separated into costs for hospital care during primary stay, hospital costs for clinical follow-up, and costs generated outside the hospital during rehabilitation. Multiple imputations were used to account for missing data.

Results: Data of 141 participants (mean age 81 years) were included in the analysis. The 2-year mortality rate was 19 %. The mean total cost per patient after 10 weeks of follow-up was €15,216. After 1 and 2 years of follow-up the mean total costs were €23,869 and €26,399, respectively. Rehabilitation was the main cost determinant, and accounted for 46 % of total costs. Primary hospital admission days accounted for 22 % of the total costs, index surgery for 11 %, and physical therapy for 7 %.

Conclusions: The main cost determinants for hemi- or total hip arthroplasty after treatment of displaced femoral neck fractures (€26,399 per patient until 2 years) were rehabilitation and nursing homes. Most of the costs were made in the first year. Reducing costs after hip fracture surgery should focus on improving the duration and efficiency of the rehabilitation phase.

Keywords: Arthroplasty; Cost analysis; Femoral neck fracture; Hip fracture; Medical costs.

Figures

Fig. 1
Fig. 1
Flow-chart of patient enrollment process. *Patients could meet more than one exclusion criterion
Fig. 2
Fig. 2
Relative contribution of costs categories to the total treatment costs of patients until 2 years of follow-up

References

    1. Cooper C, Campion G, Melton LJ., 3rd Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2(6):285–289. doi: 10.1007/BF01623184.
    1. Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407–413. doi: 10.1007/PL00004148.
    1. &D2 = 0&D3 = 0&D4 = 157&D5 = a&HDR = T,G1&STB = G2,G3,G4&CHARTTYPE = 1&VW = T (2014).
    1. (2013).
    1. Garden R. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg (Br) 1961;43:647–663.
    1. (2011).
    1. Bhandari M, Devereaux PJ, Tornetta P, 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, Schemitsch EH, Hanson BP, Koval K, Dirschl D, Leece P, Keel M, Petrisor B, Heetveld M, Guyatt GH. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005;87(9):2122–2130. doi: 10.2106/JBJS.E.00535.
    1. Iorio R, Healy WL, Lemos DW, Appleby D, Lucchesi CA, Saleh KJ. Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness. Clin Orthop Relat Res. 2001;383:229–242. doi: 10.1097/00003086-200102000-00027.
    1. Johansson T, Bachrach-Lindstrom M, Aspenberg P, Jonsson D, Wahlstrom O. The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips. Int Orthop. 2006;30(1):1–6. doi: 10.1007/s00264-005-0037-z.
    1. Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am. 2006;88(2):249–260. doi: 10.2106/JBJS.E.00215.
    1. Waaler Bjornelv GM, Frihagen F, Madsen JE, Nordsletten L, Aas E. Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial. Osteoporos Int. 2012;23(6):1711–1719. doi: 10.1007/s00198-011-1772-1.
    1. (2013).
    1. Allan GM, Lexchin J. Physician awareness of diagnostic and nondrug therapeutic costs: a systematic review. Int J Technol Assess Health Care. 2008;24(2):158–165.
    1. Chesser TJ, Ya’ish F. Should surgeons know the costs of the implants they use? Injury. 2013;44(10):1261–1262. doi: 10.1016/j.injury.2013.06.026.
    1. Streit JJ, Youssef A, Coale RM, Carpenter JE, Marcus RE. Orthopaedic surgeons frequently underestimate the cost of orthopaedic implants. Clin Orthop Relat Res. 2013;471(6):1744–1749. doi: 10.1007/s11999-012-2757-x.
    1. Zielinski SM, Bouwmans CA, Heetveld MJ, Bhandari M, Patka P, Van Lieshout EMM. The societal costs of femoral neck fracture patients treated with internal fixation. Osteoporos Int. 2014;25(3):875–885. doi: 10.1007/s00198-013-2487-2.
    1. Hakkaart-van Roijen L. Manual Trimbos/iMTA questionnaire for costs associated with psychiatric illness (in Dutch) Rotterdam: Institute for Medical Technology Assessment; 2002.
    1. .
    1. Hakkaart-van Roijen L, Tan, S.S., Bouwmans, C.A.M. (ed) (Geactualiseerde versie 2010.) Handleiding voor kostenonderzoek, methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. College voor zorgverzekeringen.
    1. Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications. Stat Med. 1991;10(4):585–598. doi: 10.1002/sim.4780100410.
    1. Briggs AH, Wonderling DE, Mooney CZ. Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ. 1997;6(4):327–340. doi: 10.1002/(SICI)1099-1050(199707)6:4<327::AID-HEC282>;2-W.
    1. Slover J, Hoffman MV, Malchau H, Tosteson AN, Koval KJ. A cost-effectiveness analysis of the arthroplasty options for displaced femoral neck fractures in the active, healthy, elderly population. J Arthroplasty. 2009;24(6):854–860. doi: 10.1016/j.arth.2008.05.008.
    1. Alolabi B, Bajammal S, Shirali J, Karanicolas PJ, Gafni A, Bhandari M. Treatment of displaced femoral neck fractures in the elderly: a cost-benefit analysis. J Orthop Trauma. 2009;23(6):442–446. doi: 10.1097/BOT.0b013e31817614dd.
    1. Frihagen F, Waaler GM, Madsen JE, Nordsletten L, Aspaas S, Aas E. The cost of hemiarthroplasty compared to that of internal fixation for femoral neck fractures. 2-year results involving 222 patients based on a randomized controlled trial. Acta Orthop. 2010;81(4):446–452. doi: 10.3109/17453674.2010.492763.
    1. Haentjens P, Autier P, Barette M, Boonen S. Costs of care after hospital discharge among women with a femoral neck fracture. Clin Orthop Relat Res. 2003;414:250–258. doi: 10.1097/01.blo.0000079262.91782.04.
    1. Nurmi I, Narinen A, Luthje P, Tanninen S. Cost analysis of hip fracture treatment among the elderly for the public health services: a 1-year prospective study in 106 consecutive patients. Arch Orthop Trauma Surg. 2003;123(10):551–554. doi: 10.1007/s00402-003-0583-z.
    1. Rogmark C, Carlsson A, Johnell O, Sembo I. Costs of internal fixation and arthroplasty for displaced femoral neck fractures: a randomized study of 68 patients. Acta Orthop Scand. 2003;74(3):293–298.
    1. De Laet CE, van Hout BA, Burger H, Weel AE, Hofman A, Pols HA. Incremental cost of medical care after hip fracture and first vertebral fracture: the Rotterdam study. Osteoporos Int. 1999;10(1):66–72. doi: 10.1007/s001980050196.

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