Health Care Management Science

, Volume 9, Issue 4, pp 359–369 | Cite as

Cost-effectiveness of referrals to high-volume hospitals: An analysis based on a probabilistic Markov model for hip fracture surgeries

Article

Abstract

Previous studies suggest that German hospitals that perform a high volume of hip fracture surgeries have a lower mortality rate and shorter length of stay than low-volume hospitals. The goal of this paper was to determine the long-term cost-effectiveness (over 20 years) of referring hip fracture surgeries to high-volume hospitals, based on data from previous studies. From a societal perspective, the cost-effectiveness ratio was €15,530 per QALY (quality-adjusted life year) (95% confidence interval €9,864–€33,048), while total annual costs to the statutory health insurance amounted up to €19.6 million. The referral of hip fracture surgeries to high-volume hospitals is thus likely to be cost-effective in Germany.

Keywords

Cost effectiveness Patient referrals Hip fractures Monte Carlo simulation Markov model 

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References

  1. 1.
    Gandjour A, Lauterbach KW (2003) The practice-makes-perfect hypothesis in the context of other production concepts in health care. Am J Med Qual 18:171–175Google Scholar
  2. 2.
    Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A (2000) Selective referral to high-volume hospitals: Estimating potentially avoidable deaths. J Am Med Assoc 283:1159–1166CrossRefGoogle Scholar
  3. 3.
    Halm EA, Lee C, Chassin MR (2002) Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 137:511–520Google Scholar
  4. 4.
    Gandjour A, Bannenberg A, Lauterbach KW (2003) Threshold volumes associated with higher survival in health care: A systematic review. Med Care 41:1129–1141CrossRefGoogle Scholar
  5. 5.
    Goodney PP, Stukel TA, Lucas FL, Finlayson EV, Birkmeyer JD (2003) Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg 238:161–167CrossRefGoogle Scholar
  6. 6.
    Epstein AM (2002) Volume and outcome—it is time to move ahead. New Engl J Med 346:1161–1164CrossRefGoogle Scholar
  7. 7.
    The Leapfrog Group (2004) Fact sheet: Evidence-based Hospital Referral, http://www.leapfroggroup.org/FactSheets/EHR_FactSheet.PDF (accessed February 7)
  8. 8.
    Wenning M, Hupe K, Scheuer I, Senninger N, Smektala R, Windhorst T (2000) Does quantity mean quality? An analysis of 116,000 patients regarding the connection between the number of cases and the quality of results. Chirurg 71:717–722CrossRefGoogle Scholar
  9. 9.
    Smektala R, Paech S, Wenning M, Hupe K, Ekkernkamp A (2002) Does hospital structure influence the outcome of operative treatment of femoral neck fractures? Zent Bl Chir 127:231–237CrossRefGoogle Scholar
  10. 10.
    Statistisches Bundesamt (2003) Gesundheitsstatistik. WiesbadenGoogle Scholar
  11. 11.
    Fritz T, Gilow C, Paffrath D (2004) Instrumente des Operations Research in der praktischen Krankenhausplanung, In: Klauber J, Robra BP, Schellschmidt H (eds.) Krankenhaus-Report 2003. Schattauer, Stuttgart, New YorkGoogle Scholar
  12. 12.
    Scottish Intercollegiate Guidelines Network (SIGN) (2005) Prevention and Management of Hip Fracture in Older People. http://www.sign.ac.uk/pdf/sign56.pdf (accessed January 6)
  13. 13.
    Chilov MN, Cameron ID, March LM (2003) Evidence-based guidelines for fixing broken hips: An update. Med J Australia 179:489–493Google Scholar
  14. 14.
    Gold MR, Siegel JE, Russell LB, Weinstein MC (eds.) (1996) Cost-Effectiveness in Health and Medicine. Oxford University Press, New YorkGoogle Scholar
  15. 15.
    Sonnenberg FA, Beck JR (1993) Markov models in medical decision making: A practical guide. Med Decis Mak 13:322–338Google Scholar
  16. 16.
    Agency for Healthcare Research and Quality (2005) http://www.ahrq.gov/ (accessed on December 29)
  17. 17.
    Braithwaite RS, Col NF, Wong JB (2003) Estimating hip fracture morbidity, mortality and costs. Journal of the American Geriatrics Society 51:364–370CrossRefGoogle Scholar
  18. 18.
    Pientka L, Friedrich C (1999) Die Kosten hüftgelenknaher Frakturen in Deutschland: Eine prospektive Studie. Z Gerontol Geriatr 32:326–332CrossRefGoogle Scholar
  19. 19.
    Siebert U (2003) Transparente Entscheidungen in Public Health mittels systematischer Entscheidungsanalyse. In: Schwartz FW, Badura B, Busse R, Leidl R, Raspe H, Siegrist J, Walter U (eds). Das Public Health Buch, Urban & Fischer, München, JenaGoogle Scholar
  20. 20.
    Kuntz K, Weinstein M (2001) Modelling in economic evaluation. In: Drummond M, McGuire A (eds) Economic Evaluation in Health Care: Merging Theory with Practice, Oxford University Press, New York, pp141–171Google Scholar
  21. 21.
    Finlayson E, Birkmeyer JD (2003) Effects of hospital volume on life expectancy after selected cancer operations in older adults: A decision analysis. J Am Coll Surg 196:410–417CrossRefGoogle Scholar
  22. 22.
    Statistisches Bundesamt (2005) Sterbetafel 2002/2004. http://www.destatis.de/download/d/bevoe/sterbet04.xls (accessed October 17)
  23. 23.
    Shapiro E, Tate R (1988) Survival patterns of nursing home admissions and their policy implications. Can J. Public Health 79:268–274Google Scholar
  24. 24.
    Bickel H (2001) Life expectancy and the need for nursing care in Germany. Gesundheitswesen 63:9–14Google Scholar
  25. 25.
    Kreder HJ, Deyo RA, Koepsell T, Swiontkowski MF, Kreuter W (1997) Relationship between the volume of total hip replacements performed by providers and the rates of postoperative complications in the state of Washington. J Bone Jt Surg 79:485–494Google Scholar
  26. 26.
    Krauth C, Hessel F, Hansmeier T, Wasem J, Seitz R, Schweikert B (2005)Empirical standard costs for health economic evaluation in Germany—a proposal by the working group methods in health economic evaluation. Gesundheitswesen 67:736–746CrossRefGoogle Scholar
  27. 27.
    Müller RT, Schurmann N (2001) Cost analysis of hip and knee prostheses as the basis for cost benefit evaluation. Zent Bl Chir 126:55–61CrossRefGoogle Scholar
  28. 28.
    Huber K. (2003) Der Einfluss der hüftgelenksnahen Femurfraktur auf das Patientenschicksal: Eine prospektive Studie unter Anwendung des SAHFE-Protokolls [dissertation]. Technische Universität München, MünchenGoogle Scholar
  29. 29.
    Bundesministerium für Gesundheit und Soziale Sicherung (2005) Krankheitskosten nach Alter und Geschlecht (2002) http://www.gbe-bund.de/ (accessed October 17)
  30. 30.
    Statistisches Bundesamt, Bericht: Pflegestatistik 2001 http://www.destatis.de/down-load/d/solei/pflstat01.pdf
  31. 31.
    Bundesregierung (2005) Leistungskatalog der Pflegeversicherung. http://www.bundesregierung.de/Artikel-,413.708498/leistungskatalog-der-pflegever.htm (accessed April 21)
  32. 32.
    Bundesministerium des Innern (2005) Siebenundzwanzigste allgemeine Verwaltungsvorschrift zur Änderung der Beihilfevorschriften. http://www.bmi.bund.de/ (accessed January 4)
  33. 33.
    Tidermark J, Zethraeus N, Svensson O, Tornkvist H, Ponzer S (2002) Femoral neck fractures in the elderly: Functional outcome and quality of life according to EuroQol. Qual Life Res 11:473–481CrossRefGoogle Scholar
  34. 34.
    Briggs AH, Ades AE, Price MJ (2003) Probabilistic sensitivity analysis for decision trees with multiple branches: Use of the Dirichlet distribution in a Bayesian framework. Med Decis Mak 23:341–350CrossRefGoogle Scholar
  35. 35.
    Stinnet AA, Mullahy J (1998) Net health benefits: A new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Mak 18:68–80Google Scholar
  36. 36.
    van Hout BA, Al MJ, Gordon GS, Rutten FF (1994) Costs, effects and C/E-ratios alongside a clinical trial. Health Econ 3:309–319Google Scholar
  37. 37.
    World Health Organization (2001) Macroeconomics and Health: Investing in Health for Economic Development. Report of the Commission on Macroeconomics and Health World Health Organization, GenevaGoogle Scholar
  38. 38.
    Birkmeyer JD, Skinner JS, Wennberg D (2002) Will volume-based referral strategies reduce costs or just save lives? Health Aff 21:234–241CrossRefGoogle Scholar
  39. 39.
    Bardach NS, Olson SJ, Elkins JS, Smith WS, Lawton MT, Johnston SC (2004) Regionalization of treatment for subarachnoid hemorrhage: A cost-utility analysis. Circulation 109:2207–2212CrossRefGoogle Scholar
  40. 40.
    Gandjour A, Lauterbach KW (2005) Does prevention save costs? Considering deferral of the expensive last year of life. J Health Econ 24:715–724CrossRefGoogle Scholar
  41. 41.
    Smektala R, Wenning M, Paech S, Windhorst T (2001) Fractures of the femoral neck—results of an external quality assurance in 32,000 patients. Z Aérztl Fortbild Qual Sich 95:209–218Google Scholar
  42. 42.
    Taylor DH Jr, Whellan DJ, Sloan FA (1999) Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries. New Engl. J Med 340:293–299CrossRefGoogle Scholar
  43. 43.
    Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie und Berufsverband der Ärzte für Orthopädie (eds.) (2002) Leitlinien der Orthopädie. Deutscher Ärzte-Verlag, KölnGoogle Scholar
  44. 44.
    Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH (2003) Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 4:CD000340Google Scholar

Copyright information

© Springer Science + Business Media, LLC 2006

Authors and Affiliations

  1. 1.Institute of Health Economics and Clinical EpidemiologyUniversity of CologneCologneGermany
  2. 2.Institut für Gesundheitsökonomie und Klinische EpidemiologieUniversität zu KölnKölnGermany

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