TY - JOUR
T1 - Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture
T2 - a cost-utility analysis alongside a multicenter prospective cohort study
AU - Loggers, S. A. I.
AU - Geraerds, A. J. L. M.
AU - Joosse, P.
AU - Willems, H. C.
AU - Gosens, T.
AU - van Balen, R.
AU - van de Ree, C. L. P.
AU - Ponsen, K. J.
AU - Steens, J.
AU - on behalf of the FRAIL-HIP study group
AU - Zuurmond, R. G.
AU - Verhofstad, M. H. J.
AU - Polinder, S.
AU - van Lieshout, Esther M. M.
N1 - Funding Information: This study was funded by the Netherlands Organization for Health Research and Development (ZonMw; ref.nr. 843004120) and Osteosynthesis and Trauma Care Foundation (ref.nr. 2019-PJKP); no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work. Funding Information: We would like to acknowledge the societies for surgery; Dutch Association for Surgery (NVvH), Dutch Association for Trauma Surgery (NVT), Dutch Orthopedic Association (NOV), Dutch Association for Orthopedic Trauma Surgery (NVOT)), clinical geriatrics (Dutch Association for Clinical Geriatrics (NVKG)), elderly care (Association of Elderly Care Physicians (VERENSO)), and the Dutch Patient Federation for their support. Furthermore, we would like to acknowledge all the participating staff and physicians in the nursing homes for the collaboration and support with the data curation. Publisher Copyright: © 2022, Authors.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Summary: Hip fractures are associated with significant healthcare costs. In frail institutionalized patients, the costs of nonoperative management are less than operative management with comparable short-term quality of life. Nonoperative management of hip fractures in patients at the end of life should be openly discussed with SDM. Purpose: The aim was to describe healthcare use with associated costs and to determine cost-utility of nonoperative management (NOM) versus operative management (OM) of frail institutionalized older patients with a proximal femoral fracture. Methods: This study included institutionalized patients with a limited life expectancy aged ≥ 70 years who sustained a proximal femoral fracture in the Netherlands. Costs of hospital- and nursing home care were calculated. Quality adjusted life years (QALY) were calculated based on EuroQol-5D-5L utility scores at day 7, 14, and 30 and at 3 and 6 months. The incremental cost-effectiveness ratio (ICER) was calculated from a societal perspective. Results: Of the 172 enrolled patients, 88 (51%) patients opted for NOM and 84 (49%) for OM. NOM was associated with lower healthcare costs at 6 months (NOM; €2425 (SD 1.030), OM; €9325 (SD 4242), p < 0.001). The main cost driver was hospital stay (NOM; €738 (SD 841) and OM; €3140 (SD 2636)). The ICER per QALY gained in the OM versus NOM was €76,912 and exceeded the threshold of €20,000 per QALY. The gained QALY were minimal in the OM group in patients who died within 14- and 30-day post-injury, but OM resulted in more than triple the costs. Conclusion: OM results in significant higher healthcare costs, mainly due to the length of hospital stay. For frail patients at the end of life, NOM of proximal femoral fractures should be openly discussed in SDM conversations due to the limited gain in QoL. Trial registration. Netherlands Trial Register (NTR7245; date 10–06-2018).
AB - Summary: Hip fractures are associated with significant healthcare costs. In frail institutionalized patients, the costs of nonoperative management are less than operative management with comparable short-term quality of life. Nonoperative management of hip fractures in patients at the end of life should be openly discussed with SDM. Purpose: The aim was to describe healthcare use with associated costs and to determine cost-utility of nonoperative management (NOM) versus operative management (OM) of frail institutionalized older patients with a proximal femoral fracture. Methods: This study included institutionalized patients with a limited life expectancy aged ≥ 70 years who sustained a proximal femoral fracture in the Netherlands. Costs of hospital- and nursing home care were calculated. Quality adjusted life years (QALY) were calculated based on EuroQol-5D-5L utility scores at day 7, 14, and 30 and at 3 and 6 months. The incremental cost-effectiveness ratio (ICER) was calculated from a societal perspective. Results: Of the 172 enrolled patients, 88 (51%) patients opted for NOM and 84 (49%) for OM. NOM was associated with lower healthcare costs at 6 months (NOM; €2425 (SD 1.030), OM; €9325 (SD 4242), p < 0.001). The main cost driver was hospital stay (NOM; €738 (SD 841) and OM; €3140 (SD 2636)). The ICER per QALY gained in the OM versus NOM was €76,912 and exceeded the threshold of €20,000 per QALY. The gained QALY were minimal in the OM group in patients who died within 14- and 30-day post-injury, but OM resulted in more than triple the costs. Conclusion: OM results in significant higher healthcare costs, mainly due to the length of hospital stay. For frail patients at the end of life, NOM of proximal femoral fractures should be openly discussed in SDM conversations due to the limited gain in QoL. Trial registration. Netherlands Trial Register (NTR7245; date 10–06-2018).
KW - Cost-utility
KW - Healthcare costs
KW - Hip fracture
KW - Nonoperative
KW - Operative
KW - Quality of life
UR - http://www.scopus.com/inward/record.url?scp=85145727555&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00198-022-06638-x
DO - https://doi.org/10.1007/s00198-022-06638-x
M3 - Article
C2 - 36609506
SN - 0937-941X
VL - 34
SP - 515
EP - 525
JO - Osteoporosis international
JF - Osteoporosis international
IS - 3
ER -