Cost-effectiveness analysis of the Geriatric Fracture Center (GFC) concept: a prospective multicentre cohort study

Joeris A, Sprague S, Blauth M, Gosch M, Wattanapanom P, Jarayabhand R, Poeze M, Wong MK, Kwek EB, Hegeman JH, Perez-Uribarri C, Guerado E, Revak TJ, Zohner S, Joseph D, Phillips MR (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Book Volume: 13

Pages Range: e072744-

Journal Issue: 11

DOI: 10.1136/bmjopen-2023-072744

Abstract

INTRODUCTION: Geriatric Fracture Centers (GFCs) are dedicated treatment units where care is tailored towards elderly patients who have suffered fragility fractures. The primary objective of this economic analysis was to determine the cost-utility of GFCs compared with usual care centres. METHODS: The primary analysis was a cost-utility analysis that measured the cost per incremental quality-adjusted life-year gained from treatment of hip fracture in GFCs compared with treatment in usual care centres from the societal perspective over a 1-year time horizon. The secondary analysis was a cost-utility analysis from a societal perspective over a lifetime time horizon. We evaluated these outcomes using a cost-utility analysis using data from a large multicentre prospective cohort study comparing GFCs versus usual care centres that took place in Austria, Spain, the USA, the Netherlands, Thailand and Singapore. RESULTS: GFCs may be cost-effective in the long term, while providing a more comprehensive care plan. Patients in usual care centre group were slightly older and had fewer comorbidities. For the 1-year analysis, the costs per patient were slightly lower in the GFC group (-$646.42), while the quality-adjusted life-years were higher in the usual care centre group (+0.034). The incremental cost-effectiveness ratio was $18 863.34 (US$/quality-adjusted life-year). The lifetime horizon analysis found that the costs per patient were lower in the GFC group (-$7210.35), while the quality-adjusted life-years were higher in the usual care centre group (+0.02). The incremental cost-effectiveness ratio was $320 678.77 (US$/quality-adjusted life-year). CONCLUSIONS: This analysis found that GFCs were associated with lower costs compared with usual care centres. The cost-savings were greater when the lifetime time horizon was considered. This comprehensive cost-effectiveness analysis, using data from an international prospective cohort study, found that GFC may be cost-effective in the long term, while providing a more comprehensive care plan. A greater number of major adverse events were reported at GFC, nevertheless a lower mortality rate associated with these adverse events at GFC. Due to the minor utility benefits, which may be a result of greater adverse event detection within the GFC group and much greater costs of usual care centres, the GFC may be cost-effective due to the large cost-savings it demonstrated over the lifetime time horizon, while potentially identifying and treating adverse events more effectively. These findings suggest that the GFC may be a cost-effective option over the lifetime of a geriatric patient with hip fracture, although future research is needed to further validate these findings. LEVEL OF EVIDENCE: Economic, level 2. TRIAL REGISTRATION NUMBER: NCT02297581.

Involved external institutions

Kepler Universitätsklinikum (KUK) Austria (AT) NYC Health + Hospitals United States (USA) (US) McMaster University Canada (CA) Bhumibol Adulyadej Hospital Thailand (TH) Bangkok Hospital Thailand (TH) Medizinische Universität Innsbruck Austria (AT) Maastricht University Netherlands (NL) Singapore General Hospital Singapore (SG) Ziekenhuisgroep Twente (ZGT) Netherlands (NL) Hospital Universitari Són Llàtzer Spain (ES) Hospital Regional de Málaga Spain (ES) Saint Louis University (SLU) United States (USA) (US) AO Foundation Switzerland (CH) Tan Tock Seng Hospital Singapore (SG)

How to cite

APA:

Joeris, A., Sprague, S., Blauth, M., Gosch, M., Wattanapanom, P., Jarayabhand, R.,... Phillips, M.R. (2023). Cost-effectiveness analysis of the Geriatric Fracture Center (GFC) concept: a prospective multicentre cohort study. BMJ Open, 13(11), e072744-. https://dx.doi.org/10.1136/bmjopen-2023-072744

MLA:

Joeris, Alexander, et al. "Cost-effectiveness analysis of the Geriatric Fracture Center (GFC) concept: a prospective multicentre cohort study." BMJ Open 13.11 (2023): e072744-.

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