Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Abstract

Background Osteoporotic hip fractures are common injuries typically occurring in patients who are older and medically frail. Studies have suggested that creation of a multidisciplinary team including orthopaedic surgeons, internal medicine physicians, social workers, and specialized physical therapists, to comanage these patients can decrease complication rates, improve time to surgery, and reduce hospital length of stay; however, they have yet to achieve widespread implementation, partly owing to concerns regarding resource requirements necessary for a comanagement program. Questions/Purposes We performed an economic analysis to determine whether implementation of a comanagement model of care for geriatric patients with osteoporotic hip fractures would be a cost-effective intervention at hospitals with moderate volume. We also calculated what annual volume of cases would be needed for a comanagement program to ''break even'', and finally we evaluated whether universal or risk-stratified comanagement was more cost effective. Methods Decision analysis techniques were used to model the effect of implementing a systems-based strategy to improve inpatient perioperative care. Costs were obtained from best-available literature and included salary to support personnel and resources to expedite time to the operating room. The major economic benefit was decreased initial hospital length of stay, which was determined via literature review and meta-analysis, and a health benefit was improvement in perioperative mortality owing to expedited preoperative evaluation based on previously conducted meta-analyses. A break-even analysis was conducted to determine the annual case volume necessary for comanagement to be either (1) cost effective (improve health-related quality of life enough to be worth additional expenses) or (2) result in cost savings (actually result in decreased total expenses). This calculation assumed the scenario in which a hospital could hire only one hospitalist (and therapist and social worker) on a full-time basis. Additionally, we evaluated the scenario where the necessary staff was already employed at the hospital and could be dedicated to a comanagement service on a part-time basis, and explored the effect of triaging only patients considered high risk to a comanagement service versus comanaging all geriatric patients. Finally, probabilistic sensitivity analysis was conducted on all critical variables, with broad ranges used for values around which there was higher uncertainty. Results For the base case, universal comanagement was more cost effective than traditional care and risk-stratified comanagement (incremental cost effectiveness ratios of All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity...

An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay

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“…29 Although the downstream financial savings associated with early initiation of osteoporosis treatment is unclear, it is reasonable to assume that we can help prevent additional fragility fractures with early intervention. 28 …”

Time to Surgery Reduction in Hip Fracture Patients on an Integrated Orthogeriatric Unit: A Comparative Study of Three Healthcare Models

“…demonstrated that an intensive and early geriatric intervention reduces mortality and the number of clinical complications, but did not find a significant effect on the LOS. From an economic perspective, it seems that collaborative models can be cost‐effective.…”

Unfallchirurgisch-geriatrisches Co-Management in der Alterstraumatologie

“…Je nach Studie konnten eine Reduktion der Mortalität und der Komplikationen und eine Verbesserung funktioneller Parameter verglichen mit der Standardtherapie erzielt werden [9,10]. In Zentren ist die integrative unfallchirurgischgeriatrische Behandlung proximaler Femurfrakturen daher auch kosteneffektiver und wirtschaftlicher als die Standardbehandlung durch eine Disziplin allein [10,11]. Auch wenn die bisherigen Studien alle zu proximalen Femurfrakturen durchgeführt wurden, ist zu vermuten, dass auch geriatrische Patienten mit anderen Verletzungen von einer unfallchirurgisch-geriatrischen Zusammenarbeit profitieren.…”