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Cost-effectiveness of a multidisciplinary co-management program for the older hip fracture patients in Beijing

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Abstract

Summary

The multidisciplinary co-management program for geriatric patients with hip fracture is cost-effective in the Chinese population and it has the potential to be scaled up in China.

Introduction

The study aimed to investigate the cost-effectiveness of a multidisciplinary co-management program for patients with hip fracture in China.

Methods

Hip fracture patients who were admitted to an orthopedic hospital in Beijing were included in the multidisciplinary co-management program. The cost-effectiveness of intervention was evaluated compared to the conventional management. A Markov microsimulation model was developed to simulate lifetime costs and effectiveness. Costs including intervention, hospitalization, medications, and long-term care costs were expressed using 2019 US dollars and the healthcare perspective was adopted. Effectiveness was evaluated using both 1-year mortality-averted and quality-adjusted life years (QALYs). Costs and effectiveness were discounted at 5% per annum. The willingness-to-pay (WTP) threshold was set at $26,481 per QALY gained which was three times gross domestic product (GDP) per capita in China. One-way and probabilistic sensitivity analyses were conducted.

Results

The lifetime cost for the conventional management (n = 1839) and intervention group (n = 1192) was $11,975 and $13,309 respectively. The lifetime QALYs were 2.38 and 2.45 years and the first-year mortality was 17.8% and 16.1%. The incremental cost-effectiveness ratio was $19,437 per QALY gained or $78,412 per 1-year mortality-averted. Given the Chinese WTP threshold, the intervention had a 78% chance being cost-effective. The cost-effectiveness of the intervention was sensitive to cost of intervention and the proportion of patients who underwent surgery within 48 h.

Conclusions

The multidisciplinary co-management program for patients with hip fracture is cost-effective and it has the potential to be scaled up in the Chinese population.

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Funding

Dr. Lei Si is supported by the National Health and Medical Research Council Early Career Fellowship (grant number GNT1139826). Professor Rebecca Ivers is supported by the National Health and Medical Research Council Senior Research Fellowship (grant number APP1136430).

Author information

Author notes

  1. K. Peng and M. Yang contributed equally to this work. R. Ivers and L. Si are equal senior aurthors.

Authors and Affiliations

  1. School of Public Health, The University of Sydney, Sydney, Australia

    K. Peng & R. Ivers

  2. The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW, 2042, Australia

    K. Peng, M. Tian, R. Ivers & L. Si

  3. Department of Orthopedic and Traumatology, Beijing Jishuitan Hospital, Beijing, China

    M. Yang & X. Wu

  4. The George Institute for Global Health at Peking University Health Science Center, Beijing, China

    M. Tian & J. Zhang

  5. School of Health Policy & Management, Nanjing Medical University, Nanjing, China

    M. Chen

  6. School of Public Health and Community Medicine, UNSW, Kensington, Australia

    J. Zhang & R. Ivers

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Correspondence to L. Si.

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Peng, K., Yang, M., Tian, M. et al. Cost-effectiveness of a multidisciplinary co-management program for the older hip fracture patients in Beijing. Osteoporos Int 31, 1545–1553 (2020). https://doi.org/10.1007/s00198-020-05393-1

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