Retrospective database study to assess the economic impact of hip fracture in the United Kingdom

Lambrelli, Dimitra; Burge, Russel; Raluy-Callado, Mireia; Chen, Shih Yin; Wu, Ning; Schoenfeld, Michael J.

doi:10.3111/13696998.2014.959588

Cited by 17 publications

(11 citation statements)

References 25 publications

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“…The percentage of patients undergoing treatment for osteoporosis with specific agents (16.7 %) or with calcium plus vitamin D (29.6 %) after hip fracture is worryingly small. These percentages are nevertheless in line with international results [7,10,17,19] and emphasize the urgent need for strategies to improve the management of osteoporosis after fracture.…”

Section: Discussionsupporting

confidence: 73%

The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality

2015

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Summary The study rationale was to provide a detailed overview of the costs, quality of life and mortality of hip fractures in Portugal. Mean individual fracture-related costs were estimated at €13, 434 [12,290; 14,576] for the first year and €5985 [4982; 7045] for the second year following the fracture. Introduction Osteoporotic fractures represent a remarkable burden to health care systems and societies worldwide, which will tend to increase as life expectancy expands and lifestyle changes favour osteoporosis. The cost-effectiveness evaluation of intervention strategies demands accurate data on the epidemiological and economical reality to be addressed. Methods Information was collected retrospectively on consumption of resources and changes in quality of life attributable to fracture as well as mortality, regarding 186 patients randomly selected to represent the distribution of hip fractures in the Portuguese population, in terms of gender, age and geographical provenience. Data were cross-tabulated with socio-demographic variables and individual resource consumption to estimate the burden of disease. A societal perspective was adopted, including direct and indirect costs.Multivariate analyses were carried out to assess the main determinants of health-related quality of life (HrQoL). Results Mean individual fracture-related costs were estimated at €13, 434 [12,290; 14,576] for the first year and €5985 [4982; 7045] for the second year following the fracture. In 2011 the economic burden attributable to osteoporotic hip fractures in Portugal could be estimated at €216 million. Mean reduction in HrQoL 12 months after fracture was estimated at 0.34. Regression analysis showed that age was associated with a higher loss of HrQoL, whereas education had the opposing effect. We observed 12 % excess mortality in the first year after hip fracture, when compared to the gender and age-matched general population. Conclusions Results of this study indicate that osteoporotic hip fractures are, also in Portugal, despite its low incidence of fractures and cost per event, associated with a high societal burden, in terms of costs, loss in HrQoL and mortality. These data provide valuable input to the design and selection of fracture prevention strategies.

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Section: Discussionsupporting

confidence: 73%

The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality

2015

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“…Also, one study estimated the marginal 1-year costs to be £4222 higher per women with hip fracture compared to women without hip fracture [ 15 ] which is considerably lower than what we found in our study. In contrast, a recent UK study, based on 8208 patients, estimated the index hospitalisation cost of a hip fracture to be similar to our estimates (£8330) [ 20 ] and the 1-year costs to be £12,475 higher compared to the year pre-fracture, which is slightly higher than our estimate (£10,860). However, the sample used in this study was younger than the typical UK hip fracture population, with the broader inclusion criteria (ICD-10: S72.0–S72.9 and M84.4, all ages, all admissions) resulting in a patient sample with a lower age at admission (mean 79 years) compared to our cohort (83 years) and the UK hip fracture audit data [ 21 ].…”

Section: Discussionsupporting

confidence: 50%

“…However, the sample used in this study was younger than the typical UK hip fracture population, with the broader inclusion criteria (ICD-10: S72.0–S72.9 and M84.4, all ages, all admissions) resulting in a patient sample with a lower age at admission (mean 79 years) compared to our cohort (83 years) and the UK hip fracture audit data [ 21 ]. Furthermore, the proportion of patients with dementia at index fracture was considerably lower than in our cohort (12 vs. 18 %), suggesting that patients admitted from a care home may have been unrepresented, which may also explain the small proportion of patients being discharged to a care home following hip fracture (4.4 % vs. 18.0 % in our study) [ 20 ]. Hence, our study contributes significantly to the evidence base regarding hip fractures by identifying and following a population of 33,172 patients with hip fractures up to 2 years before and after the index event.…”

Section: Discussionmentioning

confidence: 79%

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

et al. 2015

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SummaryUsing 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.IntroductionThe 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.MethodsA 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.ResultsA 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.ConclusionsHospital 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.

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“…However, although the outpatient dataset has been used in research (e.g. [19][20][21]), and for costing purposes in particular [22], we are not aware of any health economic RCT-based applications to date.…”

Section: Introductionmentioning

confidence: 99%

Validation of the Hospital Episode Statistics Outpatient Dataset in England

et al. 2015

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Retrospective database study to assess the economic impact of hip fracture in the United Kingdom

Abstract: Although we did not capture all pre- and post-index costs and healthcare utilization, this study provides important insights regarding the characteristics of patients with hip fracture, and information that will be useful in burden-of-illness and economic analyses.

Cited by 17 publications

References 25 publications

The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality

The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality

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

Validation of the Hospital Episode Statistics Outpatient Dataset in England

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