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The Economic Cost of Hip Fractures Among Elderly Women

A One-Year, Prospective, Observational Cohort Study with Matched-Pair Analysis

Investigation performed at Academisch Ziekenhuis van de Vrije Universiteit Brussel, Brussels; Clinique Louis Caty Baudour, Baudour; Centre Hospitalier Etterbeek Ixelles, Brussels; and Universitaire Ziekenhuizen van de Katholieke Universiteit Leuven, Leuven, Belgium
Patrick Haentjens, MD, PhD, Prof Department of Orthopaedics and Traumatology, Academisch Ziekenhuis VUB, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium. E-mail address: orthsp{at}az.vub.ac.be
Philippe Autier, MD, MPH Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, I-20141 Milan, Italy
Martine Barette, MD Unit of Epidemiology and Prevention of Cancer, Jules Bordet Institute, Boulevard de Waterloo 125, B-1000 Brussels, Belgium
Steven Boonen, MD, PhD, Prof Senior Clinical Investigator of the Fund for Scientific Research—Flanders, Belgium (F.W.O.—Vlaanderen) and holder of the Leuven University Chair in Metabolic Bone Diseases, founded and supported by Merck Sharp and Dohme
Leuven University Center for Metabolic Bone Diseases and Division of Geriatric Medicine, Katholieke Universiteit Leuven, Brusselse straat 69, B-3000 Leuven, Belgium
Although none of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article, benefits have been or will be received, but are directed solely to a research fund, foundation, educational institution, or other nonprofit organization with which one or more of the authors is associated. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was Merck Sharp and Dohme BV, Belgium.
Read at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Anaheim, California, February 4, 1999.

Background:

We conducted a prospective study to assess the costs of initial hospitalization for a first hip fracture and to evaluate the excess costs attributable to the hip fracture during the one-year period following hospital discharge.

Methods:

This investigation was designed as a one-year prospective cohort study with matched-pair analysis. Elderly women who were receiving care for a first hip fracture at four Belgian hospitals were matched, with respect to age and residence, with women (control subjects) with no history of hip fracture who lived in the same neighborhood. The initial hospitalization costs were tabulated from the hospital invoices. To estimate the costs during the year after hospital discharge, health-care services utilized by the hip-fracture patients and by the control subjects were recorded. We used the official reimbursement rates to assign a cost to these services, and the results are reported in United States dollars.

Results:

The mean age of the 159 patients who had a hip fracture was 79.3 years, and that of the 159 control subjects was 78.7 years. The total mean cost of the initial hospitalization was $9534 for the hip-fracture patients. The total direct costs during the year after discharge averaged $13,470 for the hip-fracture patients and $6170 for the control subjects. Thus, the excess direct cost during the one-year period following hospital discharge averaged $7300 for the hip-fracture patients. The largest cost differences were attributable to nursing-home stays (31%), rehabilitation-center stays (31%), hospitalizations (16%), and home physical-therapy services (14%). Two-fifths of the excess costs were spent during the three months following hospital discharge. Moreover, we observed a shift in resource utilization after hospital discharge.

Conclusions:

Our one-year prospective study demonstrated that the costs of treating a hip-fracture patient are about three times greater than those of caring for a patient without a fracture. This study also highlights the savings to society if a hip fracture can be avoided.

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