The economic cost of hip fractures among elderly women - A one-year, prospective, observational cohort study with matched-pair analysis

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.