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 hospi tal discharge. Methods: This investigation was designed as a one-year prospective cohort s tudy with matched-pair analysis. Elderly women who were receiving care for a first hip fracture at four Belgian hospitals were matched, with respect t o age and residence, with women (control subjects) with no history of hip f racture who lived in the same neighborhood. The initial hospitalization cos ts 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 o fficial reimbursement rates to assign a cost to these services, and the res ults are reported in United States dollars. Results: The mean age of the 159 patients who had a hip fracture was 79.3 y ears, and that of the 159 control subjects was 78.7 years. The total mean c ost of the initial hospitalization was $9534 for the hip-fracture patients. The total direct costs during the year after discharge averaged $13,470 fo r the hip-fracture patients and $6170 for the control subjects. Thus, the e xcess direct cost during the one-year period following hospital discharge a veraged $7300 for the hip-fracture patients. The largest cost differences w ere 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 ho spital discharge. Moreover, we observed a shift in resource utilization aft er 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 sa vings to society if a hip fracture can be avoided.