ArticleJB & JS open access
Cost-Effectiveness of Timely Surgery and Timely Inpatient Rehabilitation for the Management of Hip Fracture.
Article in JB & JS open access. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Evidence-based and quality-of-care guidelines for hip fracture have recommended providing timely surgery and postacute rehabilitation. We sought to evaluate the cost-effectiveness of providing early surgery (within 24 hours of emergency department admission) and immediate admission to inpatient rehabilitation postacute discharge, or a combination of both for the management of hip fracture patients in Ontario, Canada. Methods: We used a Markov state transition model to compare early surgery and immediate rehabilitation to surgery beyond 24 hours and no postacute rehabilitation or receiving it beyond 24 hours postacute discharge. Costs and Quality-adjusted life-years (QALYs) were estimated in a 5-year horizon for elderly patients, from the perspective of the (public) insurance payer in Ontario, using linked administrative data sets. Transition probabilities and costs were obtained from regression models fitted using linked administrative data sets. EuroQoL 5-Dimension (EQ-5D) utility values were obtained from an international prospective observational study. We performed base-case and probabilistic sensitivity analysis using 5,000 simulations for willingness-to-pay thresholds from $0-$300,000 Canadian Dollars (CAD). Results: The incremental cost-effectiveness ratio of timely rehabilitation, for both timely surgery and rehabilitation, compared with neither were $124,162 and $83,714 per QALY, respectively. Timely surgery alone was an absolute advantage strategy (Δ Cost = -$2,387, Δ QALY = 0.06). Five-year base-case costs ranged from $130,747 to $156,848 and QALYs from 2.13 to 2.37. Timely surgery alone had the highest probability of being cost-effective up to a willingness-to-pay threshold of $128,000 per QALY, whereas combined surgery and rehabilitation was favored above $130,000 per QALY. Results were qualitatively similar for common diagnoses and procedure modalities. Conclusion: Our population data and modelling results indicate that timely surgery can improve patients' quality of life while reducing costs. Adding inpatient rehabilitation yields greater QALYs but at higher cost. Level of Evidence: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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