Background

Evidence 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.

Methods

This 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.

Results

14,005 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.

Conclusion

Survival 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.

中文翻译：

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德国髋部骨折患者协作骨科护理的健康经济评估：使用健康和长期护理保险索赔数据的回顾性队列研究

 背景

有证据表明骨科共同管理（OGCM）对髋部骨折患者有好处。然而，关于成本效益的证据有限并且基于小数据集。我们研究的目的是对德国 OGCM 对老年髋部骨折患者进行经济评估。

 方法

这项回顾性队列研究基于德国健康和长期护理保险数据。个体年龄在 80 岁及以上，2014 年发生髋部骨折，并在提供 OGCM（OGCM 组）或标准护理（对照组）的医院接受治疗。在一年内对支付者和社会角度的医疗保健费用、获得的生命年 (LYG) 和成本效益进行了调查。我们应用加权伽马和两部分模型以及熵平衡来解决随机化的缺乏。我们计算了增量成本效益比（ICER），并采用净效益方法来构建成本效益可接受性曲线。

 结果

14,005 名患者在 OGCM 接受治疗，10,512 名患者在标准护理医院接受治疗。 OGCM 组中每位患者的平均医疗保健总费用较高：从付款人角度来看为 1181.53 欧元 ( p < 0.001)，从社会角度来看为 1408.21 欧元 ( p < 0.001)。从付款人角度来看，ICER 相当于 52,378.12 欧元/LYG，从社会角度来看，ICER 相当于 75,703.44 欧元/LYG。如果付款人的支付意愿高于 82,000 欧元/LYG，从社会角度来看高于 95,000 欧元/LYG，则成本效益的概率将为 95%。

 结论

提供 OGCM 的医院的生存率有所提高。由于住院和长期护理的推动，成本有所增加。成本效益取决于支付意愿。随着更长时间的随访，ICER 可能会有所改善。