Health care services and costs after hip fracture, comparing conventional versus standardised care: A retrospective study with 12-month follow-up

Abstract

Aims: To compare costs related to a standardised versus conventional hospital care for older patients after fragility hip fracture and determine whether a shift in hospital care led to cost-shifts between specialists and primary health care. Methods: We retrospectively collected and calculated volumes of care and accompanying costs from fracture time until 12 months after hospital discharge for 979 patients. All patients aged ≥ 65 years had fragility hip fractures. The data set had few missing data points because of the patient registry, administrative databases, and a low migration rate. Results: Total costs per patient at 12 months were EUR 78 164 (standard deviation [SD] 58 056) and EUR 78 068 (SD 60 131) for conventional and standardised care, respectively (p = 0.480). Total specialist care costs were significantly lower for the standardised care group (p < 0.001). Total primary care costs were higher for the standardised care group (p = 0.424). Total costs per day of life for the conventional and standardised care groups were EUR 434 and EUR 371, respectively (p = 0.003). Patients in the standardised care group had 17 more days of life. Conclusions: Implementation of a standardised care to improve outcomes for patients with hip fracture caused lower specialist care costs and higher primary care costs, indicating care- and cost-shifts from specialist to primary health care.