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

doi:10.1007/s00198-016-3484-z

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

Osteoporos Int. 2016 Jun;27(6):1999-2008. doi: 10.1007/s00198-016-3484-z. Epub 2016 Jan 28.

Authors

P T P W Burgers¹, M Hoogendoorn², E A C Van Woensel¹, R W Poolman³, M Bhandari⁴, P Patka⁵, E M M Van Lieshout⁶; HEALTH Trial Investigators

Collaborators

HEALTH Trial Investigators:
Rob Korley, Richard Buckley, Paul Duffy, Shannon Puloski, Kimberley Carcary, Melissa Lorenzo, Georgia Carstensen, Ross McKercher, Kelly Johnston, Greg Abelseth, Raul Kuchinad, Saboura Mahdavi, Emil H Schemitsch, Michael D McKee, Jeremy A Hall, Aaron Nauth, Daniel Whelan, Timothy R Daniels, Earl R Bogoch, James P Waddell, Henry Ahn, Milena R Vicente, Jennifer T Hidy, Melanie T MacNevin, Hans Kreder, Terry Axelrod, Richard Jenkinson, Markku Nousiainen, David Stephen, Veronica Wadey, Monica Kunz, Katrine Milner, Ria Cagaanan, Melanie MacNevin, Peter J O'Brien, Piotr A Blachut, Henry M Broekhuyse, Pierre Guy, Kelly A Lefaivre, Gerard P Slobogean, Raman Johal, Irene Leung, Chad Coles, Ross Leighton, C Glen Richardson, Michael Biddulph, Michael Gross, Michael Dunbar, J David Amirault, David Alexander, Catherine Coady, Mark Glazebrook, David Johnston, William Oxner, Gerald Reardon, Ivan Wong, Kelly Trask, Shelley MacDonald, Andrew Furey, Craig Stone, Minnie Parsons, Trevor Stone, Mauri Zomar, Robert McCormack, Kelly Apostle, Dory Boyer, Farhad Moola, Bertrand Perey, Darius Viskontas, Karyn Moon, Raely Moon, Yves Laflamme, Benoit Benoit, Pierre Ranger, Michel Malo, Julio Fernandes, Karine Tardif, Julie Fournier, Pascal André Vendittoli, Vincent Massé, Alain G Roy, Martin Lavigne, Daniel Lusignan, Etienne L Belzile, Pascale Levesque-Bernier, Etienne L Belzile, Luc Bédard, Pascale Levesque-Bernier, Samir Chhabra, Kelly Fusco, Craig Davis, Philip Stull, Stewart Weinerman, Peter Weingarten, Steven Lindenbaum, Michael Hewitt, Rebecca Danielwicz, Janell Baker, Michael Mont, Donald E Delanois, Bhaveen Kapadia, Kimona Issa, Marylou Mullen, Andrew Sems, Barb Foreman, Javad Parvizi, Tiffany Morrison, Courtland Lewis, Stephanie Caminiti, Thomas A Einhorn, Paul Tornetta 3rd, William R Creevy, Heather Silva, Michelle J Lespasio, Andrew Marcantonio, Michael Kain, Lawrence Specht, John Tilzey, John Garfi, Samir Mehta, John L Esterhai Jr, Jaimo Ahn, Derek Donegan, Annamarie Horan, Kelly McGinnis, James Roberson, Thomas Bradbury, Greg Erens, Kyle Webb, Brian Mullis, Karl Shively, Andrew Parr, Janos Ertl, Ripley Worman, Mark Webster, Judd Cummings, Valda Frizzell, Molly Moore, Clifford B Jones, James R Ringler, Debra L Sietsema, Jane E Walker, Enes Kanlic, Amr Abdelgawad, Juan Shunia, Charles DePaolo, Susan Sutherland, Rachel Alosky, Robert Zura, Maria Manson, Gregg Strathy, Kathleen Peter, Paul Johnson, Meaghan Morton, James Shaer, Tyson Schrickel, Barbara Hileman, Marina Hanes, Elisha Chance, E Matthew Heinrich, David Dodgin, Michele LaBadie, David Zamorano, Martin Tynan, Ran Schwarzkopf, John A Scolaro, Ranjan Gupta, Samuel Bederman, Nitin Bhatia, Bang Hoang, Douglas Kiester, Neil Jones, Gregory Rafijag, Damon Alvekios, Jason Lee, Akshay Mehta, Steven Schroder, Tom Chao, Vincent Colin, Phuc Phil Dang, Stephen Keun Heng, Gregory Lopez, Samuel Galle, Sohrab Pahlavan, Duy L Phan, Minal Tapadia, Christopher Bui, Nickul Jain, Tyler Moore, Nathan Moroski, Deeba Pourmand, Erik N Kubiak, Jeremy Gililland, David Rothberg, Christopher Peters, Christopher Pelt, Ami R Stuart, Kirby Corbey, Franklin D Schuler, James Day, Tigran Garabekyan, Felix Cheung, Ali Oliashirzi, Jonathon Salava, Linda Morgan, Timothy Wilson-Byrne, Mary Beth Cordle, Timothy J Sauber, Edward Westrick, Robert Duerr, Michael Maher, Traci Salopek, Carlos A Sagebien, David A Harwood, Stephen Kayiaros, Patricia Seuffert, Sridhar Rachala, Mark Anders, Christopher Mutty, Matthew Philips, Allison Cornwall, Mary Bayers-Thering, Michael Dohm, Cindy Fastje, Leon H G J Elmans, Joost A A M van den Hout, Adrianus J P Joosten, Ad F A van Beurden, Stefan B T Bolder, Denise Eygendaal, Adrianus F C M Moonen, Rutger C I van Geenen, Eric A Hoebink, Robert Wagenmakers, Wouter van Helden, Ydo V Kleinlugtenbelt, Hans-Peter W van Jonbergen, Herbert Roerdink, Joost M Reuver, Alexander F W Barnaart, Elvira R Flikweert, Rover Krips, J Bernard Mullers, Hans Schüller, Mark L M Falke, Frans J Kurek, Adrianus C H Slingerland, Jan P van Dijk, Wouter H van Helden, Hugo W Bolhuis, Pieter H J Bullens, Mike Hogervorst, Karin E de Kroon, Rob H Jansen, Ferry Seenstra, Eric E J Raven, W Peter J Fontijne, Saskia C Wiersma, Bastiaan Boetes, Edgar J T ten Holder, Huub J L van der Heide, Jochem Nagels, Enrike H M J van der Linden-van der Zwaag, Stefan B Keizer, Jan-Willem A Swen, Peter H C den Hollander, Bregje J W Thomassen, Rudolf W Poolman, Willem Jan Kleyn Molekamp, Frank R A J de Meulemeester, Arthur E B Kleipool, Robert Haverlag, Maarten P Simons, Eduard L A R Mutsaerts, Rob Kooijman, Roelf R Postema, René J T M Bleker, Harald I H Lampe, Lein Schuman, John Cheung, Frank van Bommel, W Paul C A Winia, Daniel Haverkamp, Harm van der Vis, Peter A Nolte, Michel P J van den Bekerom, Tjitte de Jong, Arthur van Noort, Diederik A Vergroesen, Bernard G Schutte, Harm M van der Vis, Lijkele Beimers, Jasper de Vries, Arthur W Zurcher, G H Rob Albers Albers, Maarten Rademakers, Stefan Breugem, Ibo van der Haven, Pieter Jan Damen, Gythe H Bulstra, Martin M Campo, Mathijs P Somford, Daniël Haverkamp, Susan Liew, Harvinder Bedi, Ashley Carr, Andrew Chia, Steve Csongvay, Craig Donohue, Stephen Doig, Elton Edwards, Max Esser, Richard Freeman, Andrew Gong, Doug Li, Russell Miller, Lu Ton, Otis Wang, Ian Young, Adam Dowrick, Zoe Murdoch, Claire Sage, Frede Frihagen, Lars Nordsletten, John Clarke-Jenssen, Geir Hjorthaug, Anne Christine Brekke, Elise Berg Vesterhus, Ingunn Skaugrud, Enrique Guerado, Encarnacion Cruz, Juan Ramon Cano, Miguel Angel Froufe, Lluis Marull Serra, Samer Al-dirra, Cristina Martinez, Richard Page, David Bainbridge, Richard Angliss, Ben Miller, Andrew Thomson, Graeme Brown, Simon Williams, Kevin Eng, David Bowyer, John Skelley, Chatar Goyal, Sally Beattie, Ernesto Guerra-Farfán, Jordi Teixidor Serra, Jordi Tomas Hernandez, Marc Aguilar Garcia, Vicente Molero Garcia, Sergi Barrera, Jordi Selga, Teresa Sanclemente, Maria Villar, John Bago, Miriam Garrido, Amar Rangan, Birgit Hanusch, Lucksy Kottam, William Farrington, Carol Greene, José A Boreno Beamud, Pedro Caba Doussoux, Rafael Navarro, Arantxa Capel, Emilio Delgado

Affiliations

¹ Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
² Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
³ Department of Orthopaedic Surgery, Joint Research, OLVG, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands.
⁴ Department of Clinical Epidemiology and Biostatistics, McMaster University, HSC 2C, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
⁵ Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
⁶ Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. e.vanlieshout@erasmusmc.nl.

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.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip / economics*
Female
Femoral Neck Fractures / economics
Femoral Neck Fractures / surgery*
Health Care Costs*
Humans
Male
Middle Aged
Netherlands
Prospective Studies
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding