gms | German Medical Science

Purpose: This study aimed to provide a detailed overview of the healthcare consumption and costs of patients treated for a femoral neck fracture with internal fixation. A secondary aim was to compare the costs of patients who underwent implant removal or revision surgery with patients in whom the implant was left in place.

Methods: This prospective cohort study was performed alongside the Dutch sample of an international randomized controlled trial, concerning femoral neck fracture patients treated with internal fixation. Patient characteristics, treatment and outcome data, and cost data were collected prospectively over two years post surgery. A societal perspective was adopted for calculating costs. The cost year was 2010. Resource use data were collected using hospital Case Report Forms and patient self-reports. Costs included hospital costs during the primary stay and follow-up, and costs related to rehabilitation and changes in living situation were added to compute the total costs. The 10% patients with the highest costs were analysed. Subgroup analyses were performed of (1) patients who did not require a revision surgery, (2) patients who had their implant removed (without any other revision surgery), and (3) patients who underwent one or more revision surgeries using a Kruskal-Wallis Analysis of Variance (ANOVA), and subsequent post-hoc pairwise comparison using a Mann-Whitney U-test.

Results: A total of 248 patients were included (mean age 71 years). Mean total costs per patient at two years follow-up were 19,425 euro. In the non-revision surgery patients these costs were 17,405 euro (N=137), in the patients who had an implant removal 10,066 euro (N=38), and in the revision arthroplasty patients 26,733 euro (N=67; P<0.001). Most costs were generated in the first treatment year. The main contributing factors were the costs related to primary surgery, admission days to the hospital and rehabilitation center/nursing home, outpatient physical therapy, and revision surgeries. Highest costs were generated by older patients who are less healthy and independent prefracture.

Conclusions: Mean total costs per patient at two years follow-up were 19,425 euro. The main determinant in total treatment costs was the cost of admission to a rehabilitation center/nursing home. Costs were specifically high in elderly with comorbidity, who are less independent pre-fracture, and have a long admission to the hospital and/or a nursing home. Costs were also higher in revision surgery patients. The costs of femoral neck fracture treatment with internal fixation in the Netherlands are comparable with these costs in other countries.