Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study

Summary The aim of this study was to determine the totalmedical costs for treating displaced femoral neck fractureswith hemi- or total hip arthroplasty in fit elderly patients.The mean total costs per patient at 2 years of follow-up were€26,399. These results contribute to cost awareness.Introduction The absolute number of hip fractures is risingand increases the already significant burden on society. Theaim of this study was to determine the mean total medicalcosts per patient for treating displaced femoral neck fractureswith hemi- or total hip arthroplasty in fit elderly patients.Methods The population was the Dutch sample of an internationalrandomized controlled trial consisting of femoral neckfracture patients treated with hemi- or total hip arthroplasty.Patient data and health care utilization were prospectively collectedduring a total follow-up period of 2 years. Costs wereseparated into costs for hospital care during primary stay, hospitalcosts for clinical follow-up, and costs generated outsidethe hospital during rehabilitation. Multiple imputations wereused to account for missing data.Results Data of 141 participants (mean age 81 years) wereincluded in the analysis. The 2-year mortality rate was 19 %.The mean total cost per patient after 10 weeks of follow-upwas €15,216. After 1 and 2 years of follow-up the mean totalcosts were €23,869 and €26,399, respectively. Rehabilitationwas the main cost determinant, and accounted for 46 % oftotal costs. Primary hospital admission days accounted for22 % of the total costs, index surgery for 11 %, and physicaltherapy for 7 %.Conclusions The main cost determinants for hemi- or total hiparthroplasty after treatment of displaced femoral neck fractures(€26,399 per patient until 2 years) were rehabilitationand nursing homes. Most of the costs were made in the firstyear. Reducing costs after hip fracture surgery should focus onimproving the duration and efficiency of the rehabilitationphase