costs of fragility hip fractures globally: a systematic ...10.1007/s00198-017-4153... · costs of...

$: Costs of fragility hip fractures globally: a systematic ...10.1007/s00198-017-4153... · Costs of fragility hip fractures globally: a systematic review and meta-regression analysis$
1

Costs of fragility hip fractures globally:

a systematic review and meta-regression analysis

Online Appendices

Appendix 1 – Search terms used in databases ....................................................................................... 2

Appendix 2 – Data extraction proforma ................................................................................................. 5

Appendix 3 – Quality checklist ................................................................................................................ 7

Appendix 4 – Table of included Studies .................................................................................................. 8

Appendix 5 – Supplementary Tables and Figures ................................................................................. 23

2

Appendix 1 – Search terms used in databases

Table A.1.1 – Search strategy for identifying relevant studies in Embase

Embase Searches

1 exp healthcare cost/

2 exp costs/

3 exp economics/

4 exp hip fracture/

5 exp femur neck fracture/

6 exp femur intertrochanteric fracture/

7 exp femur pertrochanteric fracture/

8 exp femur subtrochanteric fracture/

9 exp femur trochanteric fracture/

10 exp fragility fracture/

11 fracture/

12 osteoporo*.mp.

13 11 and 12

14 ("neck of femur" adj2 fracture*).mp.

15 ("femoral neck" adj2 fracture*).mp.

16 ((fracture* adj2 fragility) and (hip* or femur* or femor*)).mp.

17 1 or 2 or 3

18 4 or 5 or 6 or 7 or 8 or 9 or 10 or 13 or 14 or 15 or 16

19 17 and 18

20 limit 19 to yr="1990 -Current"

Table A.1.2 – Search strategy for identifying relevant studies in Medline

Medline Searches

1 exp economics/

2 cost*.mp.

3 osteoporo*.mp.

4 exp fracture bone/

5 3 and 4

6 exp osteoporotic fractures/

7 exp hip fracture/



10 (fracture* adj2 fragility).mp.

11 hip Fractures/ec [Economics]

12 1 or 2

13 5 or 6 or 7 or 8 or 9 or 10

14 12 and 13

15 11 or 14

16 exp animals/ not humans.sh.

17 15 not 16


3

Table A.1.3 – Search strategy for identifying relevant studies in Global health

Global

health Searches

1 fracture* neck of femur.mp.

2 fracture/ or fracture*.mp.

3 osteoporo*.mp.

4 2 and 3

5 (bone fracture* and hips).sh.

6 hip fracture*.mp.

7 fragility fracture*.mp.




11 exp costs/

12 exp economics/

13 cost*.mp.

14 1 or 4 or 5 or 6 or 7 or 8 or 9 or 10

15 11 or 12 or 13

16 14 and 15


Table A.1.4 – Search strategy for identifying relevant studies in CAB abstracts

CAB

abstracts Searches

1 fracture* neck of femur.mp.

2 fracture/ or fracture*.mp.

3 (bone fracture* and hips).sh.

4 hip fracture*.mp.

5 fragility fracture*.mp.

6 osteoporo*.mp.

7 2 and 6




11 exp costs/

12 exp economics/

13 cost*.mp.

14 1 or 3 or 4 or 5 or 7 or 8 or 9 or 10

15 11 or 12 or 13

16 14 and 15


4

Table A.1.5 – Search strategy for identifying relevant studies in Econlit

Econlit Searches

1 ((fracture* neck of femur) OR (fracture* hip) OR (fragility fracture*) OR

(osteoporo* fracture*) OR (fracture* adj2 "neck of femur") OR ("femoral

neck" adj2 fracture*) OR (fracture* adj2 fragility))

2 (cost* OR (healthcare cost*) OR economic*)

3 1 and 2

Table A.1.6 – Search strategy for identifying relevant studies in NHS EED & HTA

NHS EED &

HTA Searches

1 (hip adj2 fracture*) IN NHSEED, HTA

2 (osteoporo* adj2 fracture*) IN NHSEED, HTA

3 (fragility adj2 fracture*) IN NHSEED, HTA

4 (fracture* adj2 neck of femur) IN NHSEED, HTA

5 #1 OR #2 OR #3 OR #4

Table A.1.7 – Search strategy for identifying relevant studies in Web of science

Web of science

(Databases=SCI-

EXPANDED,

SSCI, CPCI-S,

CPCI-SSH) Searches

1 Topic=(cost*)

2 Topic=(economic*)

3 Topic=((osteoporo* NEAR/2 fracture*))

4 Topic=((fracture* NEAR/2 hip))

5 Topic=(("fracture*" NEAR/2 "neck of femur"))

6 Topic=((fragility NEAR/2 fracture*))

7 #2 OR #1

8 #6 OR #5 OR #4 OR #3

9 #8 AND #7

10 Filter = years 1990 to current

5

Appendix 2 – Data extraction proforma

1. Authors and publication date: …………………………………………………………………………………………

2. Country and region: ………………………………………………………………………………………………………

3. Study design:

Randomised control trial Prospective observational study

Cross-sectional study Retrospective observational study

4. Costing methodology:

National Reference costs Own costs (finance department)

Combination of national reference and own costs

5. Economic perspective of analysis:

Societal Healthcare system

Healthcare provider Third party payer

6. Currency: ……………………………………………………………………………………………………………………

7. Exchange rate used if not local currency: …………………………………………………………………

8. Year of costing: ……………………………………………………………………………………………………………………

9. Discount rate used: …………………………………………… Not used N/A

10. Sample size: ……………………………………………………………………………………………………………………

11. Proportion of the sample that are female: …………………………………………………………………

12. Mean age of sample: ………………………………………………………………………………………………………

13. Follow-up period of analysis: …………………………………………………………………………………………

14. Length of stay of index hospitalisation episode: …………………………………………………………………

6

15. Categories of care included:

Healthcare

Inpatient Index hospitalisation

Other inpatient

Rehabilitation Index rehabilitation

Other rehabilitation

Index “Superspell“

Community healthcare

Medication

Outpatient

Total Healthcare

Social care

Social care in the patient’s home

Social care – residential/care home

Home modification/medical equipment

Total Social Care

Total Health and Social Care

Productivity loss and informal care

Out of Pocket Expense

Income foregone by patient

Income foregone by caregiver

Total Productivity loss and informal care

Other

Total

16. Results:

Reported Cost CI/SD/SE Category of care Subgroup

1.

2.

3.

4.

n.

7

Appendix 3 – Quality checklist

CHECKLIST Yes No N/A

Study Design

1. The research question is stated

2. Economic perspective of the study is clearly stated and

justified

Data collection

3. Details of the subjects is provided

4. Indirect costs reported separately

5. Methods for estimation of unit costs and quantities is

adequately described

6. Currency and price data are reported

7. Details of adjustments for inflation or currency conversion

are reported

Analysis and interpretation of results

8. Time horizon of the study is reported

9. Discount rate is stated

10. Details of statistical tests and confidence intervals reported

11. Sensitivity analysis is performed

12. The study question is answered

13. Conclusions follow on for the data

14. Conclusions are accompanied by caveats

Questions 4, 7 and 9 were not applicable to all studies, resulting in the maximum achievable score

ranging from 11 to 14. Quality score for each study was calculated by dividing the score by the

maximum score achievable, with equal weighting assigned to each point.

8

Appendix 4 – Table of included Studies

Authors Year Country Study design Economic perspective

Category of costs

included

Subgroup Sample size (hip

fractures)

Summary costs

(2014, US$)

Breakdown of costs by category

CI, SE or SD

provided

Quality Score

Alekna V, et al [1]

2015 LTU Cross-sectional

Societal Medical - 6 10,071 Yes Yes 75%

Althausen PL, et al [2]

2014 USA Retrospective Healthcare provider

Medical Control Intervention

81 88

9,054 6,913

Not Applicable

No 83%

Autier P, et al [3]

2000 BEL Prospective Healthcare system

Medical, Social

- 170 34,218 Yes Yes 73%

Azhar A, et al [4]

2008 IRL Retrospective Healthcare system

Medical - 143 11,124 Not Applicable

No 64%

Bass E, et al [5]

2008 USA Retrospective Societal Medical, Social

- 43,104 86,633 Yes Yes 75%

Beck TS, et al [6]



Yes 58%

Bessette L, et al [7]

2012 CAN Retrospective Healthcare provider

Medical - 4,536 42,624 No Yes 54%

Blouin J, et al [8]

2009 CAN Retrospective Healthcare system


Yes 77%

Blume SW, et al [9]

2011 USA Cross-sectional

Healthcare system

Medical, Social

- 166 50,453 No Yes 55%

Bonafede M, et al [10]

2013 USA Retrospective Societal Medical, productivity

- 11,585 46,542 Yes No 92%

Borgstrom F, et al [11]

2006 SWE Retrospective Societal Medical, social,

productivity

- 278 17,159 Yes Yes 92%

Bouee S, et al [12]

2006 EUR RCT Healthcare payer

Medical France Belgium Italy Spain UK

159 14,165 14,471 13,651 18,015 16,564

No No 100%

Brainsky A, et al [13]

1997 USA Prospective Societal Medical, social,

productivity

- 759 38,626 Yes No 100%

Brenneman SK, et al [14]

2013 USA Retrospective Healthcare payer

Medical Public Private

253 575

27,171 33,058

No Yes 83%

9


Category of costs

included


fractures)

Summary costs

(2014, US$)


CI, SE or SD

provided

Quality Score

Brooks JM, et al [15]

2009 USA RCT Healthcare provider


720 658

9,195 7,481

Not Applicable

No 50%

Bubshait D, et al [16]

2007 SAU Retrospective Healthcare provider

Medical Female Men

20 23

51,823 44,932

Not Applicable

Yes 67%

Cameron ID, et al [17]

1994 AUS RCT Healthcare payer

Medical, social

Control Intervention

125 127

15,695 13,032

Yes Yes 92%

Carey D, et al [18]

2005 IRL Retrospective Healthcare provider

Medical, social

- 841 11,669 Not Applicable

No 50%

Centers for Disease Control Prevention [19]


Medical - 9,343 32,492 No No 50%

Chen L, et al [20]

2007 SGP Prospective Healthcare payer


Yes 75%

Christensen L, et al [21]



1,702 1,711

38,804 44,200

Yes Yes 83%

Clancy T, et al [22]



No 42%

Clark P, et al [23]

2008 MEX Cross-sectional

Healthcare provider

Medical, productivity

Public Public Private Private

61 118 20 19

1,991 4,841 7,662

17,009

Yes No 62%

Colla CH, et al [24]


Medical - 38,346 12,392 Yes Yes 67%

Cotter PE, et al [25]

2006 IRL Retrospective Healthcare system

Medical - 5 18,250 Yes No 50%

Cox MA, et al [26]

1993 NZL Retrospective Healthcare provider

Medical Female 65-74 Female 75+ Male

16 94 21

6,326 9,032 6,987

Yes No 50%

Cui Z, et al [27]


Medical Control Complication Complication

29,831 3,948 1,214

21,974 23,655 21,308

Not Applicable

Yes 92%

Dai KR, et al [28]

2007 CHN Retrospective Healthcare provider


- 101 6,820 Yes Yes 62%

De Laet CEDH, et al [29]

1999 NLD Prospective Healthcare system

Medical, social

- 44 38,489 Yes Yes 83%

10


Category of costs

included


fractures)

Summary costs

(2014, US$)


CI, SE or SD

provided

Quality Score

Della Rocca GJ, et al [30]

2013 USA Prospective Healthcare payer


31 115

41,281 55,977

Not Applicable

Yes 42%

Duclos A, et al [31]

2010 FRA Retrospective Healthcare provider

Medical - 6,019 24,983 Yes Yes 100%

Edwards C, et al [32]

2008 GBR Retrospective Healthcare provider

Medical Control Complication

80 80

16,033 46,322

Not Applicable

No 67%

Eekman DA, et al [33]

2014 NLD Prospective Societal Medical, social,

productivity

- 4 16,674 Yes Yes 86%

Espino D, et al [34]


Medical Hispanic Black White

2,842 3,623

119,909

20,308 26,372 22,636

Not Applicable

Yes 58%

Farnworth MG, et al [35]

1994 AUS Prospective Healthcare provider


71 67

13,161 10,984

Yes No 58%

Findorff MJ, et al [36]

2007 USA RCT Healthcare payer

Medical, social

- 4 40,675 No No 33%

French FH, et al [37]

1995 GBR Prospective Healthcare system

Medical Control Complicated

50 10

7,095 8,395

Yes Yes 75%

Frihagen F, et al [38]

2010 NOR RCT Societal Medical, social

Hemiarthroplasty Internal fixation

110 112

47,857 58,479

Yes Yes 100%

Gabriel SE, et al [39]


Medical - 187 16,161 No No 67%

Galbraith JG, et al [40]

2011 IRL Prospective Healthcare provider


No 33%

Garcia AE, et al [41]



No 50%

Gill B, et al [42]


Medical Inter-medullary nail Internal fixation

44 51

33,933 33,001

Not Applicable

Yes 25%

Gutierrez L, et al [43]

2011 GBR Retrospective Healthcare system


- 2,427 8,773 Yes Yes 75%

Heinrich S, et al [44]

2011 DEU Retrospective Healthcare payer

Medical, social

- 1,525 10,770 Yes Yes 100%

Hirose J, et al [45]

2008 JPN Retrospective Healthcare provider


650 163

14,049 20,638

Not Applicable

No 50%

11


Category of costs

included


fractures)

Summary costs

(2014, US$)


CI, SE or SD

provided

Quality Score

Hollingworth W, et al [46]

1993 GBR Prospective Healthcare provider


301 779

13,023 11,346

Yes Yes 67%

Hopkins RB, et al [47]

2013 CAN Retrospective Healthcare payer

Medical, social

Female Male

507 244

39,427 38,779

Yes Yes 64%

Iglesias CP, et al [48]

2009 GBR Cross-sectional

Societal Medical, social,

productivity

- 10 27,809 No No 75%

Iorio R, et al [49]


Medical Total hip replacement Total hip replacement Hemiarthroplasty Hemiarthroplasty Internal fixation

5 10 16 31

123

28,928 27,809 29,657 30,270 33,789

Yes No 75%

Ishizaki T, et al [50]

2004 JPN Retrospective Healthcare payer


Yes 75%

Johansson T, et al [51]

2006 SWE RCT Healthcare provider

Medical - 146 16,416 Yes Yes 67%

Kates SL, et al[52] 2010 USA Retrospective Healthcare provider


Yes 67%

Kay HF, et al [53]


Medical Internal fixation Intramedullary nail Mixed

111 92 65

66,768 69,438 64,525

Not Applicable

Yes 58%

Kazi HA, et al [54]



No 64%

Khasraghi FA, et al [55]



293 217

13,600 21,427

Not Applicable

Yes 50%

Kilgore ML, et al [56]


Medical, social

- 60,354 34,833 No Yes 75%

Kondo A, et al [57]

2009 JPN Retrospective Healthcare payer

Medical, social,

productivity

- 148 20,689 Yes Yes 69%

Kramer AM, et al [58]


Medical, social,

productivity

Control Intervention Intervention

163 101 172

25,246 12,234 17,199

Yes No 67%

Lambrelli D, et al [59]


Medical - 8,028 22,951 Yes Yes 75%

12


Category of costs

included


fractures)

Summary costs

(2014, US$)


CI, SE or SD

provided

Quality Score

Lawrence TM, et al [60]



No 75%

Lee YHD, et al [61]

2008 SGP Prospective Healthcare provider


No 73%

Leslie WD, et al [62]


Medical, social

Female Male

1,957 857

55,185 40,838

No No 100%

Leslie WD, et al [63]

2011 CAN Retrospective Healthcare system

Medical, social

Female Male

3,613 1,604

31,390 27,476

No No 75%

Liu JL, et al [64]

2014 CHN Retrospective Healthcare payer


Yes 58%

Loures FB, et al [65]

2015 BRA Retrospective Healthcare provider


83 27

3,784 2,440

Not Applicable

Yes 92%

Maravic M, et al [66]

2014 FRA Retrospective Healthcare payer

Medical Female, control Male, control Female, complication Male, complication

51,902 16,689

168 194

8,471 8,735

10,438 11,045

Not Applicable

Yes 73%

Max W, et al [67]

2002 USA Retrospective Societal Medical - 26,699 11,477 Not Applicable

No 58%

McGuire KJ, et al [68]


Medical - 18,908 21,335 No No 58%

Miura LN, et al [69]

2009 USA Prospective Healthcare provider


72 91

14,609 11,778

Not Applicable

Yes 75%

Nikitovic M, et al [70]


Medical, social,

productivity

Female Male

22,418 7,611

31,708 33,898

Yes Yes 92%

Nikkel LE, et al [71]

2012 USA Retrospective Healthcare system

32,440 Not included as only presents results as coefficients of multivariate analysis.

67%

Nurmi I, et al [72]

2003 FIN Prospective Healthcare system

Medical, social,

productivity

- 106 18,626 Yes No 83%

Ohsfeldt RL, et al [73]


Medical, social

- 1,125 33,530 No No 67%

Olsson L-E, et al [74]

2009 SWE Prospective Healthcare provider


53 55

19,286 11,686

Not Applicable

Yes 85%

Orsini LS, et al [75]


Medical - 990 25,434 No No 67%

13


Category of costs

included


fractures)

Summary costs

(2014, US$)


CI, SE or SD

provided

Quality Score

Oster G, et al [76]


Medical Control Complication Complication

198 40 59

43,147 76,417 54,210

Yes Yes 75%

Palmer SJ, et al [77]


Medical Hemiarthroplasty, control Internal fixation, control Internal fixation, control Hemiarthroplasty, complication Internal fixation, complication Internal fixation, complication

864

634

1,246

44

54

146

10,612

7,559

12,030

24,755

24,809

15,543

No No 83%

Papakonstantinou VV, et al [78]

2008 GRC Prospective Healthcare provider

Medical Internal fixation Hemiarthroplasty

82 91

3,836 7,389

Not Applicable

No 75%

Pike C, et al [79]



7,997 255

40,702 21,259

No Yes 92%

Polder JJ, et al [80]

2003 NLD Prospective Societal Medical, social,

productivity


102 106

25,077 23,349

Yes Yes 100%

Pollard TCB, et al [81]



122 61

12,875 43,589

Not Applicable

No 83%

Qu B, et al [82]

2014 CHN Prospective Societal Medical, social,

productivity

- 437 10,160 Yes Yes 77%

Randell A, et al [83]

1995 AUS Retrospective Healthcare system

Medical, social

Female Male

17 9

22,138 15,018

No No 75%

Reginster JY, et al [84]

1999 BEL Retrospective Healthcare payer

Medical - 2,374 13,639 Not Applicable

Yes 91%

Rogmark C, et al [85]

2003 SWE RCT Healthcare system

Medical, social

Arthroplasty Internal fixation

32 36

20,689 28,896

No No 75%

Roy A, et al [86]



71 47

16,325 14,062

Not Applicable

Yes 42%

14


Category of costs

included


fractures)

Summary costs

(2014, US$)


CI, SE or SD

provided

Quality Score

Saeb M, et al [87]

2014 IRN Prospective Healthcare provider


No 33%

Sahota O, et al [88]



No 80%

Schurch MA, et al [89]

1996 CHE Prospective Healthcare provider

Medical - 404 41,995 No No 67%

Shabat S, et al [90]

2003 ISR Retrospective Healthcare system


No 45%

Shi NW, et al [91]



2,423 21,504

44,159 28,933

Yes No 75%

Shields E, et al [92]


Medical Internal fixation Hemiarthroplasty

120 491

8,546 10,431

Yes Yes 58%

Sloan FA, et al [93]


Medical, social

- 109 34,490 Yes No 58%

Song X, et al [94]


Medical, social

Public, control Public, complication Private, control Private, complication

29,369 2,837 4,377 375

16,690 37,254 22,726 77,767

No No 92%

Strom O, et al [95]

2008 SWE Prospective Societal Medical, social,

productivity

- 283 20,299 Yes Yes 92%

Stromberg L, et al [96]

1997 SWE Retrospective Healthcare system

medical Control Control Intervention

1,060 1,178

93

27,404 28,836 24,449

No No 75%

Sund R, et al [97]

2011 FIN Retrospective Healthcare system

Medical Hospital A Hospital B

527 731

23,223 24,414

No Yes 50%

Tamulaitiene M, et al [98]

2012 LTU Retrospective Healthcare system

Medical - 441 20,760 No No 78%

Taylor Jr DH, et al [99]


Medical, social

Hospital A Hospital B Hospital C Hospital D Hospital E

66 110 113 117 396

21,407 19,470 25,685 21,893 21,382

Yes No 75%

Thakar C, et al [100]



288 144

13,491 29,316

Yes No 83%

15


Category of costs

included


fractures)

Summary costs

(2014, US$)


CI, SE or SD

provided

Quality Score

Thakore RV, et al [101]


Medical Complication Complication Complication

58 118 371

11,449 16,305 12,767

Not Applicable

Yes 67%

Tow BPB, et al [102]

2009 SGP Retrospective Healthcare provider


33 33

8,326 8,690

Not Applicable

No 50%

van Balen R, et al [103]

2002 NLD Prospective Healthcare provider

Medical, social


102 106

25,077 23,349

Yes Yes 75%

Viswanathan H, et al [104]


Medical, social

- 158 28,391 No Yes 92%

Waaler Bjornelv GM, et al [105]

2012 NOR RCT Societal Medical, social,

productivity

Hemiarthroplasty Internal fixation

80 86

53,337 70,886

No Yes 79%

Wiktorowicz ME, et al [106]

2001 CAN Retrospective Societal Medical, social,

productivity

Home dwelling Home to institution Institution to institution

338 61

105

24,402 50,386 38,488

Yes Yes 92%

Wong MK, et al [107]

2002 SGP Retrospective Healthcare system


No 42%

Woolcott JC, et al [108]

2012 CAN Prospective Healthcare provider

medical - 18 34,820 No Yes 75%

Woratanarat P, et al [109]

2005 THA Prospective Healthcare payer


- 37 13,429 No No 77%

Wyers CE, et al [110]

2013 NLD RCT Societal Medical, social,

productivity


79 73

28,744 29,318

Yes Yes 92%

Zethraeus N, et al [111]

1997 SWE Retrospective Healthcare system

Medical, social

- 1,709 38,698 Yes No 82%

Zhao Y, et al [112]


Medical, social

Public, control Public, complication Public, complication Private, control Private, complication Private, complication

22,522 839

2,761 4,574 132 394

30,034 44,547 50,931 41,190 96,060 72,537

No Yes 83%

Zielinski SM, et al [113]

2014 NLD RCT Societal Medical, social

- 248 24,387 Yes Yes 92%

16

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http://dx.doi.org/10.1016/j.medici.2015.01.008

http://dx.doi.org/10.1016/j.arth.2013.07.006

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Appendix 5 – Supplementary Tables and Figures

Table A5.1 – Number of included studies (left hand axis, bars) and mean quality of studies (right hand axis, circles with 95% confidence intervals) by year (n=113)

Table A5.2 - Follow-up period of included studies (n=113)

Time horizon Number of studies

Index hospitalisation or “superspell” 48

3 months 2

4 months 3

6 months 9

12 months 38

14 months 1

18 months 1

24 months 8

36 months 2

60 months 1

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

2

4

6

8

10

12

Me

an S

tud

y Q

ual

ity

Nu

mb

er

of

Stu

die

s

Year of Publication

Number of studies Mean study quality

24

Table A5.3 – Distribution of included studies by country and region (n=113)

Country Number of

Studies % a Region Regional total

United States of America 42 37.2% North America

50

Canada 8 7.1%

Great Britain 12 10.6% Western Europe

40

Sweden 7 6.2%

Netherlands 6 5.3%

Ireland 4 3.5%

Belgium 2 1.8%

Finland 2 1.8%

France 2 1.8%

Norway 2 1.8%

Germany 1 0.9%

Greece 1 0.9%

5 European countries (UK, France, Belgium, Italy, Spain)

1 0.9%

Singapore 4 3.5% Asia 11

China 3 2.7%

Japan 3 2.7%

Thailand 1 0.9%

Australia 3 2.7% Australasia 4

New Zealand 1 0.9%

Brazil 1 0.9% Latin America

3

Chile 1 0.9%

Mexico 1 0.9%

Iran 1 0.9% Middle East 3

Israel 1 0.9%

Saudi Arabia 1 0.9%

Lithuania 2 1.8% Eastern Europe

2

a – Values do not sum to 100% due to rounding

25

Figure A5.4 - Categories of care used for assigning costs.

Table A5.5 - Number of reported costs and costs with standard errors for index hospitalisation, index rehabilitation and index “Superspell”.

Category of care Observations Observations

with SD Pooled mean cost ($, 2014)

SE

Index Hospitalisation a 126 64 10,075 894

Index rehabilitation b 32 4 7,496 4,688

Index “Superspell” c 29 5 11,767 571

a – index hospitalisation relates to the initial inpatient episode immediately following hip fracture b – index rehabilitation related to rehabilitation care provided immediately following hip fracture (either in an acute hospital or in a rehabilitation ward) c – Index Superspell is a summary cost combining the cost of index hospitalisation and index rehabilitation.

Total costs

MedicalInpatient

• index hospitalisation

• other inpatient

Rehabilitation

• Index rehab

• other rehabOutpatient Primary care

Medications / Pharmacy

Social care

Social care in the home

Social care -residential /

nursing home

Medical equipment / Home modificationProductivity loss and

informal care

Out of pocket expenses


Income foregone by relative / carer

Other

26

Table A5.6 - Number of reported costs with standard error extracted from studies with a follow up period beyond the index hospital discharge by category of care and follow-up period (n=170).

Category of Care Follow-up (months)

Total 1.5 3 4 6 12 14.3 18 24 36

Inpatient 3 4 13 1 1 5 27

Inpatient (excluding index hospitalisation)

4 1 3 2 10

Rehabilitation 3 3

Outpatient 1 7 1 3 12

Primary care and community health services

1 2 4 1 8

Pharmacy 1 2 7 1 1 12

Total medical care costs 2 11 13

Medical equipment and home modification

1 2 2 1 6

Social care in the patients' homes

1 2 2 4 3 12

Social care in an institutional setting

4 3 1 1 2 1 12

Total social care costs 2 2 4

Other direct costs 1 2 3

Total direct costs (health and social care)

1 4 4 11 1 4 1 26

Out of pocket expenses 1 1

Income foregone by caregiver

1 1 1 3


2 1 3

Total productivity and informal care costs

0

Total costs 2 3 6 1 1 2 15

Total 2 8 21 18 81 4 9 25 2 170

27

Figure A5.7 - Scatter plot of cost of index hospitalisation against mean length of stay comparing

North American studies (black circles) to studies from other regions (grey circles). Solid horizontal

line = pooled mean cost of index hospitalisation ($10,075). Size of circle represents the weighting

of each observation. (n =64)

0

20

00

040

00

060

00

080

00

0

Inde

x h

osp

italis

ation

cost (U

S$, 2

01

4)

0 20 40 60 80Length of stay (days)

28

Table A5.8 - Univariate and multivariate analysis of index hospitalisation costs.

Univariate Multivariate (n=59)

Variable Marginal cost ($, 2014)

p-value Marginal cost ($, 2014)

p-value

Country and Healthcare system factors

GDP per capita -0.048 0.671 - -

Healthcare expenditure per capita -0.027 0.967 - -

% of healthcare expenditure, public -56.52 0.502 - -

Region North America (n=38)

Baseline - -

Western Europe (n=16)

-3,575 0.049 - -

Asia (n=4) -429 0.836 - -

Australasia (n=2) -910 0.556 - -

Latin America (n=2) -10,428 <0.001 - -

Middle East (n=2) 35,068 <0.001 - -

US vs. non-US studies US studies (n=35) Baseline Baseline

Non-US studies (n=29)

-4,248 0.157 10,701 0.001

Study design factors

Year of study a -389 <0.001 -292 <0.001

RCT vs. observational studies

Observational studies (N=59)

Baseline - -

RCT (n=5) 2,002 0.038 - -

Control vs. Intervention groups (n = 16) b

Control groups (n=8)

Baseline - -

Intervention group (n=8)

-1,738 <0.001 - -

Hip fracture with complications vs. hip fractures without complications (n=21) c

No complications (n=8)

Baseline - -

With complications (n=13)

1,352 <0.001 - -

Costs vs. Charges, US studies only (n=35)

Costs (n=23) Baseline - -

Charges (n=12) 6,779 0.099 - -

Demographic factors

Older age -103 0.031 - -

Gender Male Baseline Baseline

Female -332 <0.001 -134 0.001

Length of stay (n = 59) 205 <0.001 3,437 <0.001

Length of stay x non-US - - -3,304 <0.001

Intercept - - 2,481

Random effect (SD) - - 1,162

Intracluster correlation coefficient (ICC) - - 0.939

n=64 unless otherwise specified

a – centred to 1990

b – not including the cost of implementing the intervention

c – six studies reported index hospitalisation costs for both patients with no complications and

patients with complications. All costs for patients developing complications were included, as

29

defined by each study. Costs related to a range of different complication, from mild (e.g. electrolyte

abnormalities) through to severe (e.g. ischaemic events, deep wound infections and death)

costs of fragility hip fractures globally: a systematic ...10.1007/s00198-017-4153... · costs of...

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