Health-economic evaluation of collaborative orthogeriatric care for patients with a hip fracture in Germany: a retrospective cohort study using health and long-term care insurance claims data

Claudia Schulz,Hans-Helmut König,Clemens Becker,Raphael S Peter,Christian Brettschneider,Kilian Rapp,Ulrich C Liener,Gisela Büchele,Dietrich Rothenbacher

doi:10.1007/s10198-021-01295-z

Abstract

BackgroundEvidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence on cost-effectiveness is limited and based on small datasets. The aim of our study was to conduct an economic evaluation of the German OGCM for geriatric hip fracture patients.MethodsThis retrospective cohort study was based on German health and long-term care insurance data. Individuals were 80 years and older, sustained a hip fracture in 2014, and were treated in hospitals providing OGCM (OGCM group) or standard care (control group). Health care costs from payer and societal perspective, life years gained (LYG) and cost-effectiveness were investigated within 1 year. We applied weighted gamma and two-part models, and entropy balancing to account for the lack of randomisation. We calculated incremental cost-effectiveness ratios (ICER) and employed the net-benefit approach to construct cost-effectiveness acceptability curves.Results14,005 patients were treated in OGCM, and 10,512 in standard care hospitals. Total average health care costs per patient were higher in the OGCM group: €1181.53 (p < 0.001) from payer perspective, and €1408.21 (p < 0.001) from societal perspective. The ICER equalled €52,378.12/ LYG from payer and €75,703.44/ LYG from societal perspective. The probability for cost-effectiveness would be 95% if the willingness-to-pay was higher than €82,000/ LYG from payer, and €95,000/ LYG from societal perspective.ConclusionSurvival improved in hospitals providing OGCM. Costs were found to increase, driven by inpatient and long-term care. The cost-effectiveness depends on the willingness-to-pay. The ICER is likely to improve with a longer follow-up.

Highlights

Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients
Intervention and control group mainly differed in the number of quarterly periods patients had been living in nursing homes, in the amount of inpatient costs, and in index hospital volume
Difference was tested using t-test. In this retrospective cohort study, we evaluated associated costs and cost-effectiveness of hospitals providing collaborative orthogeriatric care in comparison to standard care for hip fracture patients in Germany within 1 year

Summary

Introduction

Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Total average health care costs per patient were higher in the OGCM group: €1181.53 (p < 0.001) from payer perspective, and €1408.21 (p < 0.001) from societal perspective. The proportion of older individuals is rising and expected to increase substantially in future decades [1] In this ageing population, geriatric health conditions will become highly important. Hip fractures cause high health care consumption, as they are expensive in acute and long-term care [3,4,5,6,7] Both the incidence of hip fractures and the number and severity of negative consequence after hip fracture increase with age [8,9,10]

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