AIMS: To determine the incremental cost of health care and clinical outcomes in the 12 months following incident hip fractures among postmenopausal women in the UK.
METHODS: Cohort study of women aged 50 years or older with a hospitalization for an incident hip fracture, age- and comorbidity- matched to women without any fracture. Individual oneto- one matching was performed. Cohorts were identified in The Health Improvement Network database between 2001 and 2005. Women in the hip fracture cohort were required to have a hospitalization compatible with hip fracture within 1 week of the recorded fracture date. Women were followed for 1 year to ascertain health care resource utilization (HCRU) and incremental costs of hip fractures. Costs included hospitalizations, general practitioner (GP) visits, accident and emergency visits, specialists referrals and prescription of medications.
RESULTS: A total of 2,427 women hospitalized due to a hip fracture were analyzed. The mean age was 81 years (±9.3). The median baseline Charlson comorbidity score was 1. The mean days of follow-up were 298 days for the hip fracture cohort and 340 days for the non-fracture cohort. About 18% of women without fractures were hospitalized during follow-up. Approximately 18% of women with hip fracture and 4% of women without fractures had at least one emergency admission (RR 4.7; 95% CI 3.8-5.8). There were no major differences in the proportion of women visiting the GP, having a referral, or taking prescription medications. Mortality was higher in the hip fracture cohort (18%) than in the non-fracture cohort (7%) (RR 2.5; 95% CI 2.1-3.0). The overall average cost of HCRU per woman was £5,335 for the hip fracture cohort and £1,113 for the non-fracture cohort. The overall 1-year mean incremental cost of hip fractures was £4,222. Most of the incremental cost (97%) was for hospitalizations, with an increment of £4,095 (95% CI: £3,992-£4,198). Approximately 98% of the overall incremental cost occurred in the first 6 months following the hip fracture.
CONCLUSIONS: The estimated incremental cost of hip fractures in postmenopausal women in the UK is £4,222. The increment is mostly related to the cost of hospitalization and treatment of the hip fracture. The incremental costs are likely to be underestimated and would be even larger if long-term care costs such as rehabilitation and nursing home care were captured. A higher mortality rate was recorded in the hip fracture cohort compared to the non-hip fracture cohort.
