Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort study

S. A.I. Loggers; A. J.L.M. Geraerds; on behalf of the FRAIL-HIP study group; P. Joosse; H. C. Willems; T. Gosens; R. Van Balen; C. L.P. Van de Ree; K. J. Ponsen; J. Steens; R. G. Zuurmond; M. H.J. Verhofstad; S. Polinder; Esther M.M. Van Lieshout

doi:10.1007/s00198-022-06638-x

Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort study

S. A.I. Loggers, A. J.L.M. Geraerds, on behalf of the FRAIL-HIP study group, P. Joosse, H. C. Willems, T. Gosens, R. Van Balen, C. L.P. Van de Ree, K. J. Ponsen, J. Steens, R. G. Zuurmond, M. H.J. Verhofstad, S. Polinder, Esther M.M. Van Lieshout^*

^*Corresponding author for this work

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Abstract

Summary: Hip fractures are associated with significant healthcare costs. In frail institutionalized patients, the costs of nonoperative management are less than operative management with comparable short-term quality of life. Nonoperative management of hip fractures in patients at the end of life should be openly discussed with SDM. Purpose: The aim was to describe healthcare use with associated costs and to determine cost-utility of nonoperative management (NOM) versus operative management (OM) of frail institutionalized older patients with a proximal femoral fracture. Methods: This study included institutionalized patients with a limited life expectancy aged ≥ 70 years who sustained a proximal femoral fracture in the Netherlands. Costs of hospital- and nursing home care were calculated. Quality adjusted life years (QALY) were calculated based on EuroQol-5D-5L utility scores at day 7, 14, and 30 and at 3 and 6 months. The incremental cost-effectiveness ratio (ICER) was calculated from a societal perspective. Results: Of the 172 enrolled patients, 88 (51%) patients opted for NOM and 84 (49%) for OM. NOM was associated with lower healthcare costs at 6 months (NOM; €2425 (SD 1.030), OM; €9325 (SD 4242), p < 0.001). The main cost driver was hospital stay (NOM; €738 (SD 841) and OM; €3140 (SD 2636)). The ICER per QALY gained in the OM versus NOM was €76,912 and exceeded the threshold of €20,000 per QALY. The gained QALY were minimal in the OM group in patients who died within 14- and 30-day post-injury, but OM resulted in more than triple the costs. Conclusion: OM results in significant higher healthcare costs, mainly due to the length of hospital stay. For frail patients at the end of life, NOM of proximal femoral fractures should be openly discussed in SDM conversations due to the limited gain in QoL. Trial registration. Netherlands Trial Register (NTR7245; date 10–06-2018).

Original language	English
Journal	Osteoporosis International
DOIs	https://doi.org/10.1007/s00198-022-06638-x
Publication status	E-pub ahead of print - 7 Jan 2023

Bibliographical note

Funding Information:
This study was funded by the Netherlands Organization for Health Research and Development (ZonMw; ref.nr. 843004120) and Osteosynthesis and Trauma Care Foundation (ref.nr. 2019-PJKP); no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

Publisher Copyright:
© 2022, International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.

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Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture a cost-utility analysis alongside a multicenter prospective cohort studyFinal published version, 788 KBLicence: CC BY-NC

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Loggers, S. A. I., Geraerds, A. J. L. M., on behalf of the FRAIL-HIP study group, Joosse, P., Willems, H. C., Gosens, T., Van Balen, R., Van de Ree, C. L. P., Ponsen, K. J., Steens, J., Zuurmond, R. G., Verhofstad, M. H. J., Polinder, S., & Van Lieshout, E. M. M. (2023). Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort study. Osteoporosis International. https://doi.org/10.1007/s00198-022-06638-x

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title = "Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort study",

abstract = "Summary: Hip fractures are associated with significant healthcare costs. In frail institutionalized patients, the costs of nonoperative management are less than operative management with comparable short-term quality of life. Nonoperative management of hip fractures in patients at the end of life should be openly discussed with SDM. Purpose: The aim was to describe healthcare use with associated costs and to determine cost-utility of nonoperative management (NOM) versus operative management (OM) of frail institutionalized older patients with a proximal femoral fracture. Methods: This study included institutionalized patients with a limited life expectancy aged ≥ 70 years who sustained a proximal femoral fracture in the Netherlands. Costs of hospital- and nursing home care were calculated. Quality adjusted life years (QALY) were calculated based on EuroQol-5D-5L utility scores at day 7, 14, and 30 and at 3 and 6 months. The incremental cost-effectiveness ratio (ICER) was calculated from a societal perspective. Results: Of the 172 enrolled patients, 88 (51%) patients opted for NOM and 84 (49%) for OM. NOM was associated with lower healthcare costs at 6 months (NOM; €2425 (SD 1.030), OM; €9325 (SD 4242), p < 0.001). The main cost driver was hospital stay (NOM; €738 (SD 841) and OM; €3140 (SD 2636)). The ICER per QALY gained in the OM versus NOM was €76,912 and exceeded the threshold of €20,000 per QALY. The gained QALY were minimal in the OM group in patients who died within 14- and 30-day post-injury, but OM resulted in more than triple the costs. Conclusion: OM results in significant higher healthcare costs, mainly due to the length of hospital stay. For frail patients at the end of life, NOM of proximal femoral fractures should be openly discussed in SDM conversations due to the limited gain in QoL. Trial registration. Netherlands Trial Register (NTR7245; date 10–06-2018).",

author = "Loggers, {S. A.I.} and Geraerds, {A. J.L.M.} and {on behalf of the FRAIL-HIP study group} and P. Joosse and Willems, {H. C.} and T. Gosens and {Van Balen}, R. and {Van de Ree}, {C. L.P.} and Ponsen, {K. J.} and J. Steens and Zuurmond, {R. G.} and Verhofstad, {M. H.J.} and S. Polinder and {Van Lieshout}, {Esther M.M.}",

note = "Funding Information: This study was funded by the Netherlands Organization for Health Research and Development (ZonMw; ref.nr. 843004120) and Osteosynthesis and Trauma Care Foundation (ref.nr. 2019-PJKP); no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work. Publisher Copyright: {\textcopyright} 2022, International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.",

year = "2023",

month = jan,

day = "7",

doi = "10.1007/s00198-022-06638-x",

language = "English",

journal = "Osteoporosis International",

issn = "0937-941X",

publisher = "Springer London",

}

Loggers, SAI, Geraerds, AJLM, on behalf of the FRAIL-HIP study group, Joosse, P, Willems, HC, Gosens, T, Van Balen, R, Van de Ree, CLP, Ponsen, KJ, Steens, J, Zuurmond, RG, Verhofstad, MHJ , Polinder, S & Van Lieshout, EMM 2023, 'Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort study', Osteoporosis International. https://doi.org/10.1007/s00198-022-06638-x

Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture : a cost-utility analysis alongside a multicenter prospective cohort study. / Loggers, S. A.I.; Geraerds, A. J.L.M.; on behalf of the FRAIL-HIP study group et al.

In: Osteoporosis International, 07.01.2023.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture

T2 - a cost-utility analysis alongside a multicenter prospective cohort study

AU - Loggers, S. A.I.

AU - Geraerds, A. J.L.M.

AU - on behalf of the FRAIL-HIP study group

AU - Joosse, P.

AU - Willems, H. C.

AU - Gosens, T.

AU - Van Balen, R.

AU - Van de Ree, C. L.P.

AU - Ponsen, K. J.

AU - Steens, J.

AU - Zuurmond, R. G.

AU - Verhofstad, M. H.J.

AU - Polinder, S.

AU - Van Lieshout, Esther M.M.

N1 - Funding Information: This study was funded by the Netherlands Organization for Health Research and Development (ZonMw; ref.nr. 843004120) and Osteosynthesis and Trauma Care Foundation (ref.nr. 2019-PJKP); no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work. Publisher Copyright: © 2022, International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.

PY - 2023/1/7

Y1 - 2023/1/7

N2 - Summary: Hip fractures are associated with significant healthcare costs. In frail institutionalized patients, the costs of nonoperative management are less than operative management with comparable short-term quality of life. Nonoperative management of hip fractures in patients at the end of life should be openly discussed with SDM. Purpose: The aim was to describe healthcare use with associated costs and to determine cost-utility of nonoperative management (NOM) versus operative management (OM) of frail institutionalized older patients with a proximal femoral fracture. Methods: This study included institutionalized patients with a limited life expectancy aged ≥ 70 years who sustained a proximal femoral fracture in the Netherlands. Costs of hospital- and nursing home care were calculated. Quality adjusted life years (QALY) were calculated based on EuroQol-5D-5L utility scores at day 7, 14, and 30 and at 3 and 6 months. The incremental cost-effectiveness ratio (ICER) was calculated from a societal perspective. Results: Of the 172 enrolled patients, 88 (51%) patients opted for NOM and 84 (49%) for OM. NOM was associated with lower healthcare costs at 6 months (NOM; €2425 (SD 1.030), OM; €9325 (SD 4242), p < 0.001). The main cost driver was hospital stay (NOM; €738 (SD 841) and OM; €3140 (SD 2636)). The ICER per QALY gained in the OM versus NOM was €76,912 and exceeded the threshold of €20,000 per QALY. The gained QALY were minimal in the OM group in patients who died within 14- and 30-day post-injury, but OM resulted in more than triple the costs. Conclusion: OM results in significant higher healthcare costs, mainly due to the length of hospital stay. For frail patients at the end of life, NOM of proximal femoral fractures should be openly discussed in SDM conversations due to the limited gain in QoL. Trial registration. Netherlands Trial Register (NTR7245; date 10–06-2018).

AB - Summary: Hip fractures are associated with significant healthcare costs. In frail institutionalized patients, the costs of nonoperative management are less than operative management with comparable short-term quality of life. Nonoperative management of hip fractures in patients at the end of life should be openly discussed with SDM. Purpose: The aim was to describe healthcare use with associated costs and to determine cost-utility of nonoperative management (NOM) versus operative management (OM) of frail institutionalized older patients with a proximal femoral fracture. Methods: This study included institutionalized patients with a limited life expectancy aged ≥ 70 years who sustained a proximal femoral fracture in the Netherlands. Costs of hospital- and nursing home care were calculated. Quality adjusted life years (QALY) were calculated based on EuroQol-5D-5L utility scores at day 7, 14, and 30 and at 3 and 6 months. The incremental cost-effectiveness ratio (ICER) was calculated from a societal perspective. Results: Of the 172 enrolled patients, 88 (51%) patients opted for NOM and 84 (49%) for OM. NOM was associated with lower healthcare costs at 6 months (NOM; €2425 (SD 1.030), OM; €9325 (SD 4242), p < 0.001). The main cost driver was hospital stay (NOM; €738 (SD 841) and OM; €3140 (SD 2636)). The ICER per QALY gained in the OM versus NOM was €76,912 and exceeded the threshold of €20,000 per QALY. The gained QALY were minimal in the OM group in patients who died within 14- and 30-day post-injury, but OM resulted in more than triple the costs. Conclusion: OM results in significant higher healthcare costs, mainly due to the length of hospital stay. For frail patients at the end of life, NOM of proximal femoral fractures should be openly discussed in SDM conversations due to the limited gain in QoL. Trial registration. Netherlands Trial Register (NTR7245; date 10–06-2018).

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U2 - 10.1007/s00198-022-06638-x

DO - 10.1007/s00198-022-06638-x

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JO - Osteoporosis International

JF - Osteoporosis International

SN - 0937-941X

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Loggers SAI, Geraerds AJLM, on behalf of the FRAIL-HIP study group, Joosse P, Willems HC, Gosens T et al. Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort study. Osteoporosis International. 2023 Jan 7. Epub 2023 Jan 7. doi: 10.1007/s00198-022-06638-x

Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort study

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