We conducted a prospective study to assess the costs of initial
hospitalization for a first hip fracture and to evaluate the excess
costs attributable to the hip fracture during the one-year period
following hospital discharge.
This investigation was designed as a one-year prospective cohort
study with matched-pair analysis. Elderly women who were receiving
care for a first hip fracture at four Belgian hospitals were matched, with
respect to age and residence, with women (control subjects) with
no history of hip fracture who lived in the same neighborhood. The
initial hospitalization costs were tabulated from the hospital invoices.
To estimate the costs during the year after hospital discharge,
health-care services utilized by the hip-fracture patients and by
the control subjects were recorded. We used the official reimbursement
rates to assign a cost to these services, and the results are reported
in United States dollars.
The mean age of the 159 patients who had a hip fracture was 79.3
years, and that of the 159 control subjects was 78.7 years. The
total mean cost of the initial hospitalization was $9534
for the hip-fracture patients. The total direct costs during the
year after discharge averaged $13,470 for the hip-fracture
patients and $6170 for the control subjects. Thus, the
excess direct cost during the one-year period following hospital
discharge averaged $7300 for the hip-fracture patients.
The largest cost differences were attributable to nursing-home stays (31%),
rehabilitation-center stays (31%), hospitalizations (16%),
and home physical-therapy services (14%). Two-fifths of
the excess costs were spent during the three months following hospital
discharge. Moreover, we observed a shift in resource utilization
after hospital discharge.
Our one-year prospective study demonstrated that the costs of
treating a hip-fracture patient are about three times greater than
those of caring for a patient without a fracture. This study also
highlights the savings to society if a hip fracture can be avoided.