Societal Benefits of Hip Fracture Surgery Exceed Direct Medical Costs

By Will Boggs MD

September 04, 2014

NEW YORK (Reuters Health) - Hip fracture has societal economic benefits that exceed the direct medical costs, according to an analysis of Medicare claims.

Surgical treatment of hip fractures provides better survival and functional outcomes than nonoperative treatment does, but less is known about its economic benefits.

As reported August 5th online in Clinical Orthopaedics and Related Research, Dr. Lane Koenig from KNG Health Consulting LLC, Rockville, Maryland and colleagues used a Markov cohort analysis to evaluate the economic value of surgical treatment of hip fractures, for patients 65 and older and for society in general.

The estimated lifetime benefits to society from surgical treatment of hip fracture amounted to an average of $65,279 per patient with displaced intracapsular fracture and by an average of $67,964 per patient with extracapsular fracture, the authors said.

Although the cost of surgery for displaced intracapsular fractures averaged $19,710 more than nonoperative treatment, the reduced long-term medical costs and reduced nursing home use averaged nearly $85,000.

For extracapsular fractures, excess surgical costs ($22,317) were more than offset by long-term economic benefits ($90,281).

Total societal savings and increased quality-adjusted life-years from surgical treatments varied considerably across age groups, but even for patients in their 90s, surgery was still cost-effective, the researchers say.

At the national level, they estimate, these savings would have amounted to $16 billion for elderly patients in 2009, with more than 95% of the benefits coming from avoided nursing home costs, which largely accrued to state Medicaid programs and patients.

"Our study is the first to our knowledge to quantify the economic value of surgical treatment of hip fractures in terms of reduced lifetime societal costs," the researchers conclude. "Future studies also might consider that additional benefits to society from improved employment and productivity resulted from successful surgical treatment of hip fractures, as more elderly workers choose to stay in the labor force longer."

Dr. Koenig did not respond to a request for comments.

Dr. Joseph Bernstein from University of Pennsylvania in Philadelphia, who has published extensively on the treatment of hip fractures, told Reuters Health by email, "I was not surprised (nor would many be) but this is important work nonetheless. The issue is that the assumption that all hip fractures need to be fixed (soon) will be called into question. After all, end of life care is known to be expensive, and it is worth talking about how to minimize these expenses. And in that regard, many patients with hip fractures are apt to die soon; so it would be reasonable to ask if fixing these broken bones is indeed cost-effective."

"This paper will be influential in the sense that it will help keep surgery as the standard of care for hip fracture, even with increased concern about limiting spending on patients with not much longer to live," Dr. Bernstein concluded.

SOURCE: http://bit.ly/1A6RSgd

Clin Orthop Relat Res 2014.

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