Health Care Management Science

, Volume 9, Issue 4, pp 359–369

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



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.


Cost effectiveness Patient referrals Hip fractures Monte Carlo simulation Markov model 


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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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