The cost of convenience: initial costs to the state healthcare system of orthopaedic injuries in uninsured delivery motorcyclists in Cape Town

Background Since the COVID-19 pandemic, there has been a reported increase in the number of delivery motorcyclists on South African roads with a resultant increase in trauma from accidents noted anecdotally in South African state hospitals. Our primary aim was to estimate the costs to the state healthcare system of the initial orthopaedic surgical management of uninsured motorcyclists involved in delivery-related accidents. The secondary aim was to describe the demographics and orthopaedic injury patterns seen in these delivery motorcyclists. Methods A prospective consecutive case series was gathered from all the hospitals draining a regional health district over the course of one year. Medical records as well as data gathered from an interview on admission were assessed to establish demographic and injury data. Theatre invoices and clinical records were used to generate cost estimates. Results Forty-four young male delivery motorcyclists who sustained a total of 57 injuries requiring orthopaedic surgical intervention were included in the study. Injuries were predominantly fractures of the femur and tibia, consistent with the described mechanism of injury. The mean cost of admission, imaging, implants and orthopaedic surgery was R52 061 per injured driver. In total, R3.99 million was spent on the initial orthopaedic surgical management of these 44 drivers. Conclusion Delivery motorcyclists are predominantly young males without major medical comorbidities who typically sustain injuries to the lower limbs consistent with being struck by another vehicle. Their initial orthopaedic surgical management is costly and resource intensive. We suggest further efforts to legislate with respect to mandatory insurance policies and safety strategies for this vulnerable group of patients. Further research into the associated costs of these injuries is needed.