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The societal costs of femoral neck fracture patients treated with internal fixation

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The study rationale was to provide a detailed overview of the costs for femoral neck fracture treatment with internal fixation in the Netherlands. Mean total costs per patient at 2-years follow-up were €19,425. Costs were higher for older, less healthy patients. Results are comparable to internationally published costs.


The aim of this study was to provide a detailed overview of the cost and healthcare consumption of patients treated for a hip fracture with internal fixation. A secondary aim was to compare costs of patients who underwent a revision surgery with patients who did not.


The study was performed alongside the Dutch sample of an international randomized controlled trial, concerning femoral neck fracture patients treated with internal fixation. Patient characteristics and healthcare consumption were collected. Total follow-up was 2 years. A societal perspective was adopted. Costs included hospital costs during primary stay and follow-up, and costs related to rehabilitation and changes in living situation. Costs were compared between non-revision surgery patients, implant removal patients, and revision arthroplasty patients.


A total of 248 patients were included (mean age 71 years). Mean total costs per patient at 2-years follow-up were €19,425. In the non-revision surgery patients total costs were €17,405 (N = 137), in the implant removal patients €10,066 (N = 38), and in the revision arthroplasty patients €26,733 (N = 67). The main contributing costs were related to the primary surgery, admission days, physical therapy, and revision surgeries.


The main determinant was the costs of admission to a rehabilitation center/nursing home. Costs were specifically high in elderly with comorbidity, who were less independent pre-fracture, and have a longer admission to the hospital and/or a nursing home. Costs were also higher in revision surgery patients. The 2-years follow-up costs in our study were comparable to published costs in other Western societies.

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Members of the research team received a grant from Fonds NutsOhra (grant number T-0602-43), The Netherlands Organization for Health Research and Development (ZonMw; grant number 171102008), Physicians’ Services Incorporated Foundation (grant number 08–18), Canadian Institutes of Health Research (grant number 177466), and National Institutes of Health (grant number 1R01-AR055267-01A1). The funding agencies were not involved in the study design, data collection, data analysis, manuscript preparations or publication decisions for this manuscript.

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Correspondence to E. M. M. Van Lieshout.

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The full list of the FAITH trial investigators is shown in the Appendix section of the article.

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Appendix: FAITH trial investigators

Appendix: FAITH trial investigators

Steering Committee: Mohit Bhandari (Chair), Marc Swiontkowski, Philip J. Devereaux, Gordon Guyatt, Martin J. Heetveld, Kyle Jeray, Susan Liew, Emil H. Schemitsch, Lehana Thabane, Stephen Walter

Global Methods Centre: Mohit Bhandari (Principal Investigator); Sheila Sprague (Research Program Manager); Taryn Scott, Marilyn Swinton, Helena Viveiros (Research Coordination); Diane Heels-Ansdell, Qi Zhou (Statistical Analysis); Lisa Buckingham, Aravin Duraikannan (Data Management); Deborah Maddock (Grants Manager) (McMaster University)

US Methods Centre: Marc Swiontkowski (Principal Investigator); Julie Agel (Research Coordination) (University of Minnesota)

Netherlands Method Centre: Martin J. Heetveld (Principal Investigator); Esther M.M. Van Lieshout (Research Coordination); Stephanie M. Zielinski (Trial Coordination) (Erasmus MC, University Medical Center Rotterdam)

UK Methods Centre: Amar Rangan (Principal Investigator); Birgit Hanusch (Research Coordination) (The James Cook University Hospital)

Central Adjudication Committee: Gregory J Della Rocca (Chair), Robert Haverlag, Susan Liew, Gerard Slobogean

Data Safety Monitoring Board: Jeffrey Katz (Chair), Brenda Gillespie, Gail A. Greendale, Pierre Guy, Curtis Hartman, Craig Rubin, James Waddell

Netherlands Cost analysis support: Clazien A.M. Bouwmans, Elly A. Stolk, Martijn Kroonen, Hamza Jap-Tjong (Institute for Medical Technology Assessment, Erasmus University Rotterdam)

Clinical Site Investigators

The following persons participated in the FAITH Study:

Canada: Robert McCormack, Kelly Apostle, Dory Boyer, Farhad Moola, Bertrand Perey, Trevor Stone, Darius Viskontas, H. Michael Lemke, Mauri Zomar, Karyn Moon, Raely Moon, Amber Oatt (Royal Columbian Hospital); Richard E. Buckley, Paul Duffy, Robert Korley, Shannon Puloski, Kelly Johnston, James Powell, Kimberly Carcary (Foothills Medical Centre); David Sanders, Abdel Lawendy, Christina Tieszer (London Health Sciences Centre); David Stephen, Hans Kreder, Richard Jenkinson, Markku Nousiainen, Terry Axelrod, John Murnaghan, Diane Nam, Robin Richards,. Sebastian Rodriguez-Elizalde, Veronica Wadey, Albert Yee, Katrine Milner, Monica Kunz, Melanie MacNevin, Ria Cagaanan (Sunnybrook Health Sciences Centre); Ryan Bicknell, Jeff Yach, Davide Bardana, Gavin Wood, Mark Harrison, David Yen, Sue Lambert, Fiona Howells, Angela Ward (Human Mobility Research Centre, Queen’s University and Kingston General Hospital); Chad Coles, Ross Leighton, Michael Biddulph, David Johnston, Mark Glazebrook, David Alexander, Cathy Coady, Michael Dunbar, Kelly Trask, Shelley MacDonald, Gwen Dobbin (Queen Elizabeth II Health Sciences Centre); Emil H. Schemitsch, Henry Ahn, Jeremy A Hall, Michael D McKee, Daniel B Whelan, Aaron Nauth, Milena Vicente, Lisa Wild, Ryan Khan, and Jennifer Hidy (St. Michael’s Hospital); Paul Zalzal, Heather Brien, V. Naumetz, Brad Weening, Nicole Simunovic (Oakville Trafalgar Memorial Hospital); Eugene K. Wai, Steve Papp, Wade T. Gofton, Allen Liew, Stephen P. Kingwell, Darren M. Roffey, Vivian Borsella (Ottawa Hospital); Victoria Avram (Juravinski Hospital and Cancer Centre)

USA: Todd M. Oliver, Vicki Jones (Boone Hospital Center—Columbia Orthopaedic Group); Clifford Jones, James Ringler, Terrence Endres, Debra L. Sietsema (Orthopaedics Associates of Michigan); Kyle J. Jeray, J. Scott Broderick, David R. Goetz, Thomas B. Pace, Thomas M. Schaller, Scott E. Porter, Stephanie L. Tanner, Rebecca G. Snider, Lauren A. Nastoff, Shea A. Bielby (Greenville Hospital System); Andrew J Marcantonio, Richard Iorio, John Garfi (Lahey Clinic); Michael J. Prayson, Richard Laughlin, Joseph Rubino, Jedediah May, Geoffrey Ryan Rieser, Liz Dulaney-Cripe, Chris Gayton (Miami Valley Hospital); Julie A. Switzer, Peter A. Cole, Sarah A. Anderson, Paul M. Lafferty, Mengnai Li, Thuan V. Ly, Scott B. Marston, Amy L. Foley, Sandy Vang, David M. Wright (Regions Hospital-University of Minnesota); Heather A. Vallier, Andrea Dolenc, Chalitha Robinson (MetroHealth Medical Center); John T. Gorczyca, Jonathan M. Gross, Catherine A. Humphrey, Stephen Kates, Krista Noble, Allison W McIntyre, Kaili Pecorella (University of Rochester Medical Center); James Shaer, Tyson Schrickel, Barbara Hileman (St. Elizabeth Health Center); Craig A. Davis, Stewart Weinerman, Peter Weingarten, Philip Stull, Stephen Lindenbaum, Michael Hewitt, John Schwappach, Janell K. Baker (Colorado Orthopedic Consultants); Samir Mehta, John Esterhai, Jaimo Ahn, Annamarie D. Horan, Kelly McGinnis, Christine A. Kaminski, Brynn N. Kowalski (University of Pennsylvania); Lisa K. Cannada, David Karges, Leslie Hill (St. Louis University Hospital); Ivan Tarkin, Peter Siska, Gary Gruen, Andrew Evans, Dana J. Farrell, James Irrgang, Arlene Luther (University of Pittsburgh Medical Center); Jonathan P. Keeve, Christopher G. Anderson, Michael D. McDonald, Jodi M. Hoffman (Northwest Orthopaedic Specialists); Mark Jenkins, Jules Dumais, Amanda W. Romero (Texas Tech University Health Sciences Center—Lubbock); Joseph R. Hsu, James Ficke, Michael Charlton, Matthew Napierala, Mary Fan (US Army Institute of Surgical Research); William W. Cross III, Joseph R. Cass, Stephen A. Sems, Michael E. Torchia, Tyson Scrabeck (Mayo Clinic); Carlos A. Sagebien, Mark S. Butler, James T. Monica, Patricia Seuffert (University Orthopaedic Associates, LLC); Michael L. Brennan, Robert Probe, Evelyn Kile, Kelli Mills, Lydia Clipper, Michelle Yu, Katie Erwin (Scott and White Memorial Hospital); Paul Tornetta III, Hope Carlisle, Heather Silva (Boston University Medical Center); Michael Archdeacon, Ryan Finnan, Toan Le, John Wyrick, Shelley Hess (UC Health/University of Cincinnati Medical Center); Jessica McBeth (Santa Clara Valley Medical Center); Kamran Aurang, Gary Zohman, Brett Peterson, Roger B. Huff, (Kaiser Permanente); Joseph Baele, Timothy Weber, Matt Edison (OrthoIndy); Andrew H. Schmidt, Jerald R. Westberg (Hennepin County Medical Center); Charles J. DePaolo, Rachel Alosky, Leslie E. Shell, Lynne Hampton, Stephanie Shepard, Tracy Nanney, Claudine Cuento (Mission Hospital Research Institute); Karl Shively, Janos P. Ertl, Brian Mullis, J. Andrew Parr, Ripley Worman, Valda Frizzell, Molly M. Moore, Erin Tobias, Emily Thomas (Indiana University—Wishard Health Services); Robert V. Cantu, Eric R. Henderson, Linda S. Eickhoff (Dartmouth-Hitchcock Medical Center); David P. Zamorano, Deeba Pourmand, Deanna Lawson (University of California Irvine Medical Center); E. Mark Hammerberg, Philip Stahel, David Hak, Cyril Mauffrey, Douglas Gibula, Hannah Gissel, Corey Henderson (Denver Health Medical Center); Gregory J. Della Rocca, Brett D. Crist, Yvonne M. Murtha, Melinda McPherson, Linda K. Anderson (University of Missouri Health Care); Michael P. Dohm, Abby Zellar (Western Slope Study Group); Colleen Linehan, Lindsey Pilling (Covenant Healthcare of Saginaw) Daniel Horwitz, Kent Strohecker (Geisinger Medical Center); Courtland G. Lewis, Stephanie Caminiti, Raymond J. Sullivan, Elizabeth Roper (University of Connecticut—Hartford Hospital); William Obremskey, Philip Kregor, Justin E. Richards, Kenya Stringfellow (Vanderbuilt University Medical Center)

The Netherlands: J. Carel Goslings, Robert Haverlag, Kees Jan Ponsen. (Academic Medical Center); Maarten W.G.A. Bronkhorst, Onno R. Guicherit (Bronovo Ziekenhuis); Peter Patka, Martin G. Eversdijk, Rolf Peters, Dennis Den Hartog, Oscar J.F. Van Waes, Pim Oprel (Erasmus MC, University Medical Center Rotterdam); Piet A.R. de Rijcke, Cees L. Koppert, Steven E. Buijk, Richard P.R. Groenendijk, Imro Dawson, Geert W.M. Tetteroo, Milko M.M. Bruijninckx, Pascal G. Doornebosch, Eelco J.R. de Graaf (IJsselland Ziekenhuis); Martin J. Heetveld, Gijs A. Visser, Heyn Stockmann, Rob Silvis, Jaap P. Snellen, Bram Rijbroek, Joris J.G. Scheepers, Erik G.J. Vermeulen, Michiel P.C. Siroen, Ronald Vuylsteke, Hans L.F. Brom, Herman Rijna (Kennemer Gasthuis); Gert R Roukema, Hong Josaputra, Paul Keller, Peter D. de Rooij, Hans Kuiken, Han Boxma, Berry I. Cleffken, Ronald Liem (Maasstad Ziekenhuis); Steven J. Rhemrev, Coks H.R. Bosman, Alexander de Mol van Otterloo, Jochem Hoogendoorn, Alexander C. de Vries, Sven A.G. Meylaerts (Medisch Centrum Haaglanden); Rudolf W. Poolman, Maarten P. Simons, Frank H.W.M. van der Heijden, W. Jaap Willems, Frank R.A.J. de Meulemeester, Cor P. van der Hart, Kahn Turckan, Sebastiaan Festen, Frank de Nies, Robert Haverlag, Nico J.M. Out, Jan Bosma (Onze Lieve Vrouwe Gasthuis); Maarten van der Elst, Carmen C. van der Pol, Martijne van ’t Riet, Tom M. Karsten, Mark R. de Vries, Laurents P.S. Stassen, Niels W.L. Schep, G. Ben Schmidt, W.H. Hoffman (Reinier de Graaf Gasthuis); Michiel J.M. Segers, Jacco A.C. Zijl, Bart Verhoeven, Anke B. Smits, Jean Paul P.M. de Vries, Bram Fioole, Henk van der Hoeven, Evert B.M. Theunissen, Tammo S. de Vries Reilingh, Lonneke Govaert, Philippe Wittich, Maurits de Brauw, Jan Wille, Peter M.N.Y.M. Go, Ewan D. Ritchie, Ronald N. Wessel, Eric R. Hammacher (St. Antonius Ziekenhuis); Michiel H.J. Verhofstad, Joost Meijer, Teun van Egmond, Frank H.W.M. van der Heijden, Igor van der Brand (St. Elisabeth Ziekenhuis); Harm M van der Vis, Martin Campo, Ronald Verhagen, G.H. Robert Albers, Arthur W. Zurcher (Tergooi Ziekenhuizen); Albert van Kampen, Jan Biert, Arie B. van Vugt, Michael J.R. Edwards, Taco J. Blokhuis, Jan Paul M. Frölke, Leo M.G. Geeraedts, Jean W.M. Gardeniers, Edward T.C.H. Tan, Lodewijk M.S.J. Poelhekke, Maarten C. de Waal Malefijt, Bart Schreurs (University Medical Center St. Radboud); Rogier K.J. Simmermacher, Jeroen van Mulken, Karlijn van Wessem, Taco J. Blokhuis, Steven M. van Gaalen, Luke P.H. Leenen (University Medical Center Utrecht)

International: Susan Liew, Harvinder Bedi, Ashley Carr, Andrew Chia, Steve Csongvay, Hamish Curry, Stephen Doig, Craig Donohue, Elton Edwards, Greg Etherington, Andrew Gong, Arvind Jain, Doug Li, Russell Miller, Ash Moaveni, Matthias Russ, Lu Ton, Otis Wang, Zoe Murdoch, Claire Sage (The Alfred, Australia); Frede Frihagen, John Clarke-Jenssen, Geir Hjorthaug, Torben Ianssen, Asgeir Amundsen, Jan Egil Brattgjerd, Tor Borch, Berthe Bøe, Bernhard Flatøy, Sondre Hasselund, Knut Jørgen Haug, Kim Hemlock, Tor Magne Hoseth, Geir Jomaas, Thomas Kibsgård, Bjørn Kristiansen, Tarjei Lona, Gilbert Moatshe, Oliver Müller, Marius Molund, Tor Nicolaisen, Fredrik Nilsen, Jonas Rydinge, Morten Smedsrud, Are Stødle, Axel Trommer, Stein Ugland, Elise Berg Vesterhus, Anne Christine Brekke (Ulleval University Hospital, Norway); Ateet Sharma, Amir Sanghavi (Satellite Orthopaedic Hospital and Research Centre, India); Kevin Tetsworth, Donald Geoff, Patrick Weinrach, Paul Pincus, Steven Yang, Brett Halliday, Trevor Gervais, Michael Holt, Annette Flynn (Royal Brisbane and Women’s Hospital, Australia); Amal Shankar Prasad, Vimlesh Mishra (Madhuraj Nursing Home, India); Ajay Gupta, Niraj Jain (Nirmal Hospital, India); Mahesh Bhatia, Vinod Arora, Mahesh Bhatia (RLB Hospital and Research Centre, India); D.C. Sundaresh, Angshuman Khanna (M.S. Rammaiah Medical College & Hospital, India); Anil Rai, Subash (Highway Hospital, India); Marinis Pirpiris, David Love, Andrew Bucknill, Richard J Farrugia (Royal Melbourne Hospital, Australia); Akhil Dadi, Naveen Palla (Sunshine Hospital, India); B. Sachidananda Rai, Janakiraman Rajakumar (Unity Health Complex, India); Joe Joseph Cherian, Davy J Olakkengil, Gaurav Sharma (St John’s Medical College Hospital, India)

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Zielinski, S.M., Bouwmans, C.A.M., Heetveld, M.J. et al. The societal costs of femoral neck fracture patients treated with internal fixation. Osteoporos Int 25, 875–885 (2014).

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