Direct costs of hip fractures in patients over 60 years of age in Belgium

Objective: Osteoporosis-related costs are now considered a major burden for health authorities in most developed countries. An accurate and exhaustive evaluation of these costs would be a major contribution to health economic studies evaluating the efficiency of screening and prevention strategies. Osteoporosis is the most frequent underlying cause of femoral neck fracture s in the elderly; these fractures weigh heavily on healthcare budgets. Howe ver, in Belgium, very few data on the financial burden of hip fractures are available and no updated estimates have been made. The goal of this paper is to estimate the direct medical expenditures associated with hip fracture s in Belgium in 1996. Design and setting: This 1-year population-based cross-sectional study is c onducted from the social security perspective. The target population in thi s study are men and women aged 60 years and over. Patients and participants: We selected patients who had been hospitalised f or a hip fracture during the year 1996 who were also affiliated with a regi stered social security organisation (covering 25% of the Belgian population ). The sample constituted 2374 patients. Interventions: For each of these patients, we collected an exhaustive and d etailed list of healthcare resource use as well as nursing home admissions following the hip fracture event. Cost items investigated in the analysis w ere inpatient hospital costs and outpatient costs. Mean annual costs per ca se recorded in the sample were then extrapolated to the whole country on th e basis of an exhaustive list of diagnoses having lead to all countrywide h ospitalisations (1 700 000 hospital stays/year). Main outcome measures and results: The mean hospital inpatient costs for hi p fracture were evaluated at 332 148 Belgian francs (BeF) [$US8977] per cas e and BeF4 367 746 200 ($US 118 047 194) for the whole country (10 million inhabitants). Patients with a hip fracture experienced an annual BeF27 825 ($US752) extra outpatient cost during the year following this fracture even t, after correcting for costs related to additional comorbidity already pre sent before the hip fracture. Finally, after a proximal femoral neck fractu re, the rate of nursing home admission was higher, both fur men and women a t any age compared with age- and gender-matched population. Conclusions: With a total cost (acute hospital and outpatient costs) of Be F4 667 893 950 (SUS126 159 323) per year in Belgium, proximal femoral neck fracture should be considered a major health economic problem and appropria te measures to prevent this disease should be rapidly undertaken.