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

作者：Sverre A. I. Loggers, Alexandra J. L. M. Geraerds, Pieter Joosse, Hanna C. Willems, Taco Gosens, Romke van Balen, Cornelis L. P. van de Ree, Kornelis J. Ponsen, Jeroen Steens, Rutger G. Zuurmond, M.H.J. Verhofstad, Suzanne Polinder, Esther M.M. Van Lieshout, on behalf of the FRAIL-HIP study group · 发表于：Osteoporosis International · 年份：2023 · DOI：10.1007/s00198-022-06638-x · 被引用次数：18 · 研究领域：Hip and Femur Fractures、Bone health and osteoporosis research、Total Knee Arthroplasty Outcomes

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-d...