Study of the incremental cost and clinical burden of hip fractures in postmenopausal women in the United Kingdom

Figures & data

Figure 1.  Age distribution of women in the hip fracture cohort.

Table 1.  Healthcare resource use and clinical outcomes during the 12 months following start date.

	Hip fracture cohort	Non-fracture cohort	Relative risk or mean difference (MD) (95% CI)
Number of all women	2,427	2,427	NA
Mean duration of follow-up (days)	298	340	NA
Hospitalizations, n (%)*	2,427 (100.0)	432 (17.8)	5.62 (5.16–6.12)
A&E visits, n (%)*	442 (18.2)	95 (3.9)	4.65 (3.75–5.77)
GP visits, n (%)*	2,141 (88.2)	2,200 (90.6)	0.97 (0.95–0.99)
Referral visits, n (%)*	805 (33.2)	776 (32.0)	1.04 (0.96–1.12)
Prescribed medications, n (%)*	2,165 (89.2)	2,259 (93,1)	0.96 (0.94–0.98)
Number of prescriptions, mean (SD)†	60.29 (67.08)	47.95 (46.03)	MD, 12.34 (8.96–15.72)
Deaths, n (%)	439 (18.1)	175 (7.2)	2.51 (2.13–2.96)
Women with at least one subsequent fracture, n (%)	124 (5.1)	NA	NA

Relative risk and mean difference calculations are for hip fracture cohort versus non-fracture cohort.

*Women with at least one encounter.

†Mean number of prescription in women with at least one medication.

A&E, accident and emergency; CI, confidence interval; GP, general practitioner; MD, mean difference; NA, not applicable; SD, standard deviation.

Table 2.  Overall costs by healthcare resource component in women with a hip fracture–related hospitalization over matched controls in the non-fracture cohort.

Cost category	Overall cost (£) Mean (standard deviation)
	Full year (0–365 days)		First 6 months (0–180 days)
	Hip fracture cohort	Non-fracture cohort	Hip fracture cohort	Non-fracture cohort
Total cost	5,335.49 (2,641.93)	1,113.37 (1,270.07)	4,719.01 (2,333.60)	567.67 (781.11)
Costs due to hospitalization	4,390.47 (2,445.48)	295.72 (862.87)	4,204.21 (2,269.34)	151.47 (598.16)
Costs due to A&E visits	21.60 (55.60)	4.90 (33.63)	17.74 (44.67)	2.34 (16.41)
Costs due to GP visits	233.66 (249.56)	239.40 (237.49)	133.16 (160.08)	122.62 (142.72)
Costs due to referrals	82.25 (154.92)	71.92 (139.93)	50.13 (117.55)	35.05 (92.02)
Costs due to medications	607.52 (742.86)	501.42 (650.39)	313.77 (386.32)	256.19 (363.88)

A&E, accident and emergency; GP, general practitioner.

Table 3.  Overall incremental costs, by healthcare resource component, in women with a hip fracture-related – hospitalization over matched controls in the non-fracture cohort.

Cost category	Overall incremental cost, GBP (£) Mean difference (95% confidence interval) [p-value]
	Full year (0–365 days)	First 6 months (0–180 days)	Second 6 months (181–365 days)
Total cost	4,222.13	4,151.34	70.79
	(4,105.48, 4,338.78)	(4,053.41, 4,249.27)	(21.59, 119.99)
	[<0.001]	[<0.001]	[0.005]
Costs due to hospitalization	4,094.75	4,052.75	42.00
	(3,991.55, 4,197.95)	(3,959.35, 4,146.14)	(4.36, 79.64)
	[<0.001]	[<0.001]	[0.029]
Costs due to A&E visits	16.69	15.40	1.30
	(14.11, 19.28)	(13.50, 17.29)	(−0.17, 2.76)
	[<0.001]	[<0.001]	[0.082]
Costs due to GP visits	−5.74	10.53	−16.28
	(−19.45, 7.97)	(2.00, 19.07)	(−23.84, −8.71)
	[0.411]	[0.016]	[<0.001]
Costs due to referrals	10.33	15.08	−4.75
	(2.03, 18.64)	(9.14, 21.02)	(−9.84, 0.34)
	[0.015]	[<0.001]	[0.067]
Costs due to medications	106.09	57.58	48.51
	(66.80, 145.39)	(36.46, 78.70)	(27.24, 69.79)
	[<0.001]	[<0.001]	[<0.001]

A&E, accident and emergency; GP, general practitioner.

Table 4.  Overall costs of hip fracture in the UK: current study versus published studies, with and without rehabilitation costs.

Reference	Cost year	Original currency (exchange rate, where relevant)	Cost (£) of hip fracture
			Not including rehabilitation cost	Rehabilitation cost		Including rehabilitation cost	Inflation-adjusted total costs (2006–2007)*
				Original cost	Inflation-adjusted costs (2006–2007)*
Current study	2006–2007	£	5,335	NA	4,601 (average of previous research)†	NA	9,936
Hollingworth et al., 199318	1991–1992	£	3,705	1,901‡§	3,356	5,606	9,897
Hollingworth et al., 199519	1991–1992	£	2,809	2,120§¶	3,743	4,929	8,701
Bouee et al., 200620	2002	€ (€1 = £0.7055**)	3,198	3,026††	3,517	6,224	7,233
French et al.,199521	1993	£	2,495	1,053§	1,682	3,548	5,666
Dolan and Torgerson, 199814	1995–1996	£	4,972	7,152‡‡	10,705	12,124	18,146
Lawrence et al., 200515	2003	£	12,163§§	NA	NA	NA	13,442‡‡
Stevenson et al., 200622	2002–2004	£	10,760§§	NA	NA	NA	11,891‡‡
Finnern and Sykes, 200323	2001	€ (€1 = £0.625**)	5,542¶¶	NA	NA	NA	6,667§§

*Inflated using inflation indices for Hospital and Community Health Services, as issued by the PPSRU (personal communication).

†Average based on 2006/2007 inflated rehabilitation costs from the five published studies that presented rehabilitation costs separately.

‡Cost of inpatient rehabilitation estimated based on the proportion of days on geriatric ward (18.1) of the total inpatient stay (41.7), and adjusted based on estimated cost of inpatient day of £400/day for the first 5 days, and £120/day for the following days (estimated from Figure 2 in Hollingworth et al., 199318).

§Outpatient rehabilitation not included.

¶Cost of inpatient rehabilitation estimated based on the proportion of days on geriatric ward (19.81) of the total inpatient stay (34.39), and adjusted based on estimated cost of inpatient days, using the method described for Hollingworth et al., 199318.

**Original conversion rate from original publications (Bouee et al., 200620; Finnern and Sykes, 200323).

††Including inpatient and outpatient rehabilitation (including home rehabilitation costs).

‡‡Including inpatient and outpatient rehabilitation, as well as follow-up, long-term hospital stay, and social care costs (including chiropody, physiotherapy, occupational therapy, social work, health visitor, district nursing, night attendance, laundry, bath attendant, meals, home care, day care, day hospital, respite care, GP domiciliary, GP surgery and outpatient care).

§§Including inpatient costs only, not including rehabilitation costs.

¶¶Including inpatient and outpatient costs, not including any rehabilitation costs.

NA, not available.

WHO Study Group on Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group. Technical Report Series No. 843. Geneva: World Health Organization, 1994. Available at: http://whqlibdoc.who.int/trs/WHO_TRS_843.pdf. [Last accessed 6 December 2009]

 Google Scholar

SAS/STAT software. Version 9 for the SAS System for Windows. Cary, NC: SAS Institute Inc., 2002–2003

 Google Scholar

van Staa TP, Leufkens HGM, Cooper C. Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 2002;13:624-9

 PubMed Web of Science ®Google Scholar

Bouee S, Lafuma A, Fagnani F, et al. Estimation of direct unit costs associated with non-vertebral osteoporotic fractures in five European countries. Rheumatol Int 2006;26:1063-72

 PubMed Web of Science ®Google Scholar

French FH, Torgerson DJ, Porter RW. Cost analysis of fracture of the neck of femur. Age Ageing 1995;24:185-9

 Google Scholar

Preliminary national report 2009. London: National Hip Fracture Database, 2009. Available at: http://www.ccad.org.uk/nhfd.nsf/6ec433ed9efaa78e802572e3003a3517/ed40fa45ba9877108025779f0041fbca/$FILE/Preliminary%20National%20Report.pdf. [Last accessed 6 December 2010]

 Google Scholar

Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83

 PubMedGoogle Scholar

Stevenson MD, Davis SE, Kanis JA. The hospitalisation costs and out-patient costs of fragility fractures. Women’s Health Med 2006;3:149-51

 Google Scholar

Cummings SR, Melton LJ 3rd.. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002;359:1761-7

 PubMed Web of Science ®Google Scholar

Cummings SR, Black DM, Rubin SM. Lifetime risks of hip, Colle’s, or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med 1989;149:2445-8

 PubMed Web of Science ®Google Scholar