Efficacy and cost-effectiveness analysis of post-acute care for elderly patients with hip fractures

Min-Chang Lee; Chia-Wei Chang; Shih-Liang Shih; Sheng-Jean Huang; Jau-Yih Tsauo; Kai-Lun Hsiao; Meng-Yueh Chien

doi:10.1016/j.jfma.2022.01.002

Efficacy and cost-effectiveness analysis of post-acute care for elderly patients with hip fractures

J Formos Med Assoc. 2022 Aug;121(8):1596-1604. doi: 10.1016/j.jfma.2022.01.002. Epub 2022 Jan 20.

Authors

Min-Chang Lee¹, Chia-Wei Chang², Shih-Liang Shih³, Sheng-Jean Huang⁴, Jau-Yih Tsauo⁵, Kai-Lun Hsiao³, Meng-Yueh Chien⁶

Affiliations

¹ Center for Athletic Health Management, Taipei City Hospital, Renai Branch, Taipei, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
² Center for Athletic Health Management, Taipei City Hospital, Renai Branch, Taipei, Taiwan.
³ Department of Orthopaedic, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan.
⁴ Taipei City Hospital, Taipei, Taiwan; Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁵ School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁶ School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: mychien@ntu.edu.tw.

PMID: 35065880
DOI: 10.1016/j.jfma.2022.01.002

Abstract

Background/purpose: Hip fractures are associated with physical dysfunction, and poor quality of life in the elderly. Post-acute care (PAC) would facilitate functional recovery in patients with hip fractures after surgeries. Taiwan has proposed a nationwide PAC program for hip fractures since 2017, but little has been known about its effectiveness. Therefore, this study aimed to evaluate the efficacy and cost-effectiveness of the PAC program for hip fracture patients in Taiwan.

Methods: This was a prospective study. Patients aged ≥ 65 years with hip fractures after surgeries were recruited and divided into home-based, hospital-based, and control groups. Outcome measures included pain, physical function (sit-to-stand test, Barthel Index [BI], and Harris hip score [HHS]), and quality of life (EuroQol instrument [EQ-5D]). Direct medical and non-medical costs were recorded. Cost-effectiveness ratio (CER) was calculated as the amount of New Taiwanese Dollars (NTDs) paid per BI and EQ-5D unit improvement.

Results: Forty-one patients participated in this study, with 17, 12, and 12 in the home-based, hospital-based, and control groups, respectively. The home-based group showed significant improvements in BI and HHS compared to the controls (p = 0.018 and p = 0.029, respectively). The hospital-based group demonstrated significant improvement in EQ-5D compared to the controls (p = 0.015). The home-based PAC program demonstrated the best CER for BI (NTD 554) and EQ-5D (NTD 41948).

Conclusion: Both PAC programs would significantly improve the physical function and quality of life in patients with hip fractures. However, the home-based PAC provided the best CER for BI and EQ-5D.

Keywords: Cost-effectiveness analysis; Hip fractures; Home-based care; Hospital-based care; Post-acute care.

MeSH terms

Aged
Cost-Benefit Analysis
Hip Fractures* / surgery
Humans
Prospective Studies
Quality of Life
Subacute Care*