Economic analysis of surgical treatment of hip fracture in older adults

Abstract

OBJECTIVE To analyze the incremental cost-utility ratio for the surgical treatment of hip fracture in older patients.METHODS This was a retrospective cohort study of a systematic sample of patients who underwent surgery for hip fracture at a central hospital of a macro-region in the state of Minas Gerais, Southeastern Brazil between January 1, 2009 and December 31, 2011. A decision tree creation was analyzed considering the direct medical costs. The study followed the healthcare provider’s perspective and had a one-year time horizon. Effectiveness was measured by the time elapsed between trauma and surgery after dividing the patients into early and late surgery groups. The utility was obtained in a cross-sectional and indirect manner using the EuroQOL 5 Dimensions generic questionnaire transformed into cardinal numbers using the national regulations established by the Center for the Development and Regional Planning of the State of Minas Gerais. The sample included 110 patients, 27 of whom were allocated in the early surgery group and 83 in the late surgery group. The groups were stratified by age, gender, type of fracture, type of surgery, and anesthetic risk.RESULTS The direct medical cost presented a statistically significant increase among patients in the late surgery group (p < 0.005), mainly because of ward costs (p < 0.001). In-hospital mortality was higher in the late surgery group (7.4% versus 16.9%). The decision tree demonstrated the dominance of the early surgery strategy over the late surgery strategy: R$9,854.34 (USD4,387.17) versus R$26,754.56 (USD11,911.03) per quality-adjusted life year. The sensitivity test with extreme values proved the robustness of the results.CONCLUSIONS After controlling for confounding variables, the strategy of early surgery for hip fracture in the older adults was proven to be dominant, because it presented a lower cost and better results than late surgery.

Radiographic anatomy of the proximal femur: femoral neck fracture vs. transtrochanteric fracture

“…However, bone mass alone is not a determining factor. 3 , 4 A study by Cummengs et al 22 found that Japanese women had lower BMD than their Caucasian peers; however, the former suffered fewer fractures. Likewise, age and BMI may not be directly related to loss in bone mass.…”

“… 3 This issue is relevant due to the high morbidity and mortality, high postoperative disability index, and increasing costs to society with less beneficial results related to treatment. 4 These fractures are considered one of the largest public health problems in the world. 4 According to American statistics, over 250,000 hip fractures occur each year; it is expected that over the next 30 years, there will be an increase of 100% in the number of cases/year.…”

“… 4 These fractures are considered one of the largest public health problems in the world. 4 According to American statistics, over 250,000 hip fractures occur each year; it is expected that over the next 30 years, there will be an increase of 100% in the number of cases/year. In Brazil, in 2010, the incidence was 100,000 fractures per year, and the mean mortality one year after the fracture was 30%.…”

Cirurgias realizadas em idosos em um hospital público do interior de São Paulo

“…Estudo conduzido nos países da União Europeia mostrou que em 2010 ocorreram 610 mil fraturas de quadril/fêmur em idosos com mais de 70 anos 14 e, no Brasil, entre 2008 e 2012, foram 38.755 fraturas de fêmur, de modo que essa ocorrência vem aumentando nas últimas décadas 2 . As fraturas são resultantes de quedas e fragilidades ósseas e têm como consequência a perda da independência e os altos índices de morbidade e mortalidade, elevando os custos para o sistema de saúde 15 . Diante dessa realidade, ressaltamos a importância da implementação das medidas preventivas recomendadas pela OMS 16 .…”

Instruments for quality of life assessment in individuals with human papillomavirus

“…Considering that generic questionnaires may be applied in several situations, the EQ-5D instrument was used to evaluate QoL in older adults submitted to hip reconstruction surgeries (25) . This instrument was validated into Portuguese, showing good acceptability and validity in the health status measurement of individuals with different pathologies such as cataract, asthma, chronic obstructive pulmonary disease, and rheumatoid arthritis (26) .…”