A health economic analysis of the management of open lower limb fractures in the elderly

Caitlin Pley,Katie Purohit,Matija Krkovic,Ali Abdulkarim

doi:10.1007/s00590-020-02713-3

Abstract

AimThe aim of this study was to investigate the financial implications of the inpatient management of open lower limb fractures in adults over 65 years old. Further, the study compares the calculated cost to the income received by the hospital for these patients and to the existing body of literature.MethodsThis study employed direct inpatient costing analysis to estimate the cost of treating the open lower limb fractures incurred by 58 patients over the age of 65 years treated in our centre (Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust) between March 2014 and March 2019.ResultsThe median cost of inpatient care calculated in this study was £20,398 per patient, resulting in a financial loss to the hospital of £5113 per patient. When the results were disaggregated by sex, the median cost for an open lower limb fracture in a male patient was £20,886 compared to £19,304 in a female patient. Data were also disaggregated by the site of injury, which produced a median cost for an open femur fracture of £23,949, and £24,549 and £15,362 for open tibia and ankle fractures, respectively.ConclusionThis study provides a valuable estimate of the expense of treating open lower limb fractures in patients over the age of 65 years in a Major Trauma Centre in England. The study highlights the large losses incurred by hospitals in treating these cases, and supports revision of the remuneration structures in the National Health Service to adequately cover their cost.

Highlights

The cost of modern health care is a major public policy issue in many countries worldwide; one that incites widespread public debate and often finds itself centre stage in political campaigns and election manifestos
United Kingdom (UK) government health care spending per capita is near the median for the Organisation for Economic Cooperation and Development (OECD) but is the second lowest of the G7 countries [3]
Our findings are consistent with a recent study, which found that 62.5% of major trauma in older persons (65 years and older) is caused by a low fall [20]

Summary

Introduction

The cost of modern health care is a major public policy issue in many countries worldwide; one that incites widespread public debate and often finds itself centre stage in political campaigns and election manifestos. In the United Kingdom (UK), health care expenditure has more than doubled in the last 50 years [1]. UK government health care spending per capita is near the median for the Organisation for Economic Cooperation and Development (OECD) but is the second lowest of the G7 countries [3]. In the NHS, hospitals are aggregated in organisational units called Trusts, which are constructed both by geographical area and the specialist functions of the facilities. The expenditures of the Trust are reimbursed by the central NHS budget based not on the actual expenditures, but on Healthcare Resource Group (HRG) cost codes. HRG tariffs are designed to incentivise providers to reduce their unit costs by finding ways to improve efficiency [5]

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