The economic burden associated with hip fractures calls for the investigation of innovative new cost-utility forms of organisation and integration of services for these patients.
Objective
To carry out a cost-utility analysis integrating epidemiological and economic aspects for hip fracture patients treated within a comprehensive orthogeriatric model (COGM) of care, as compared with standard of care model (SOCM).
Design
A demonstration study conducted in a major tertiary medical centre, operating both a COGM ward and standard orthopaedic and rehabilitation wards.
Methods
Data was collected on the clinical outcomes and health care costs of the two different treatment modalities, in order to calculate the absolute cost and disability-adjusted life years (DALY) ratio.
Results
The COGM model used 23% fewer resources per patient ($14,919 vs. $19,363) than the SOCM model and to avert 0.226 additional DALY per patient, mainly as a result of lower 1-year mortality rates among COGM patients (14.8% vs. 17.3%).
conclusion
A comprehensive ortho-geriatric care modality is more cost-effective, providing additional quality-adjusted life years (QALY) while using fewer resources compared with standard of care approach. The results should assist health policy-makers in optimising healthcare use and healthcare planning.
KanisJAOdénAMcCloskeyEVJohanssonHWahlDACooperCon behalf of the IOF Working Group on Epidemiology and Quality of Life. A systematic review of hip fracture incidence and probability of fracture worldwide.Osteoporos Int2012;23(9):2239–56
2.
BraithwaiteRSNanandaFWongJBEstimating hip fracture morbidity, mortality and costs. J Amer Geriatr Soc2003;51(3):364–70
3.
PueyoMJLarrosaMSurísXGarcia-RuizAJCost-utility and budget impact analysis of primary prevention with alendronate of osteoporotic hip fractures in Catalonia. Reumatol Clin2012;8(3):128–34
4.
McLellanARWolowaczSEZimovetzEAFracture 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 Int2011;22(7):2083–98
5.
MajumdarSRLierDABeaupreLAOsteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Arch Intern Med2009;169(1):25–31
6.
McGuireKJChackoATBernsteinJCost-effectiveness of teaching hospitals for the operative management of hip fractures. Orthopedics2011;5; 34(10):e598–601
7.
GandjourAWeylerE-JCost-effectiveness of referrals to high-volume hospitals: an analysis based on a probabilistic Markov model for hip fracture surgeries. Health Care Manag Sci2006;9(4):359–69
8.
HoWWKwan DaiDLLiuKWTo investigate the effect and cost-effectiveness of implementing an orthogeriatric intervention for elderly patients with acute hip fracture: the experience in Hong Kong. J Am Geriatr Soc2009;57(11):2153–4
9.
González MontalvoJIGotor PérezPMartín VegaAThe acute orthogeriatric unit. Assessment of its effect on the clinical course of patients with hip fractures and an estimate of its financial impact.Rev Esp Geriatr Gerontol2011;46(4):193–9
10.
KammerlanderCGoschMBlauthMLechleitnerMLugerTJRothTThe Tyrolean Geriatric Fracture Center: an orthogeriatric co-management model. Z Gerontol Geriatr2011;44(6):363–7
11.
SletvoldOHelbostadJLThingstadPEffect of in-hospital comprehensive geriatric assessment (CGA) in older people with hip fracture. The protocol of the Trondheim Hip Fracture trial.BMC Geriatr2011;1118
12.
González-MontalvoJIAlarcónTMauleónJLGil-GarayEGotorPMartín-VegaAThe orthogeriatric unit for acute patients: a new model of care that improves efficiency in the management of patients with hip fracture. Hip Int2010;20(2):229–35
13.
PioliGGiustiABaroneAOrthogeriatric care for the elderly with hip fractures: where are we?Aging Clin Exp Res2008;20(2):113–22
14.
AdunskyALuskyAAradMHerutiRJA comparative study of rehabilitation outcomes of elderly hip fracture patients: the advantage of a comprehensive orthogeriatric approach. J Gerontol A Biol Sci Med Sci2003;58(6):542–7
15.
AdunskyALerner-GevaLBlumsteinTBoykoVMizrahiEAradMImproved survival of hip fracture patients treated within a comprehensive geriatric hip fracture unit, compared with standard of care treatment. J Am Med Dir Assoc2011;12(6):439–44
16.
AdunskyAAradMLeviRBlanksteinAZeiligGMizrachiEFive-year experience with the 'Sheba' model of comprehensive orthogeriatric care for elderly hip fracture patients. Disabil Rehabil2005;2718-191123–7
17.
AdunskyALeviRCecicAAradMNoySBarellVThe “Sheba” model of comprehensive orthogeriatric care for elderly hip fracture patients: a preliminary report. Isr Med Assoc J2002;4(4):259–61
18.
Central Bureau of Statistics, Annual Statistical Abstract 2010, CBS, Jerusalem2010
19.
GinsbergGGuidelines for the submission of Cost Utility Analyses of candidate Interventions for the Health Basket, Israel Ministry of Health2009
WHO Commission on MacroEconomics and Health. Macroeconomics and health: investing in health for economic development. Report of the commission on Macroeconomics and health. Geneva: World Health Organization, 2001
MurrayCJLLopezADedsThe global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 projected to 2020. WHO, World Bank1996
24.
JenqGTinettiMEThe journey across the health care (dis)continuum for vulnerable patients: policies, pitfalls and possibilities. JAMA2012;307(20):2157–8
25.
KammerlanderCRothTFriedmanSMOrtho-geriatric service-a literature review comparing different models. Osteoporos Int2010;21Suppl 4S637–46
26.
ZukerIRasoolyILaksarIFindings of the National Survey of Rehabilitation Care for the Elderly in Israel. Israel Centre of Disease Control publication Number 347 October 2011
27.
National Center for Injury Prevention and Control, Centers for Disease Control and PreventionHip Fractures in Older Adults. Available at:http://www.cdc.gov/ncipc/factsheets/adulthipfx.htm. Accessed May 23, 2012.
28.
Protecting fragile bones. A strategy to reduce the impact of osteoporosis and fragility fractures in Wales.Building stronger bonesAvailable at:http://www.nos.org.uk/netcommunity/document.doc?id=491. Accessed May 23, 2012.
