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The healthcare system costs of hip fracture care in South Africa

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Abstract

Summary

Despite rapidly ageing populations, data on healthcare costs associated with hip fracture in Sub-Saharan Africa are limited. We estimated high direct medical costs for managing hip fracture within the public healthcare system in SA. These findings should support policy decisions on budgeting and planning of hip fracture services.

Purpose

We estimated direct healthcare costs of hip fracture (HF) management in the South African (SA) public healthcare system.

Methods

We conducted a micro-costing study to estimate costs per patient treated for HF in five regional public sector hospitals in KwaZulu-Natal (KZN), SA. Two hundred consecutive, consenting patients presenting with a fragility HF were prospectively enrolled. Resources used including staff time, consumables, laboratory investigations, radiographs, operating theatre time, surgical implants, medicines, and inpatient days were collected from presentation to discharge. Counts of resources used were multiplied by unit costs, estimated from the KZN Department of Health hospital fees manual 2019/2020, in local currency (South African Rand, ZAR), and converted to 2020 US$ prices. Generalized linear models estimated total covariate-adjusted costs and cost predictors.

Results

The mean unadjusted cost for HF management was US$6935 (95% CI; US$6401–7620) [ZAR114,179 (95% CI; ZAR105,468–125,335)]. The major cost driver was orthopaedics/surgical ward costs US$5904 (95% CI; 5408–6535), contributing to 85% of total cost. The covariate-adjusted cost for HF management was US$6922 (95% CI; US$6743–7118) [ZAR113,976 (95% CI; ZAR111,031–117,197)]. After covariate adjustment, total costs were higher in patients operated under general anaesthesia [US$7251 (95% CI; US$6506–7901)] compared to surgery under spinal anaesthesia US$6880 (95% CI; US$6685–7092) and no surgery US$7032 (95% CI; US$6454–7651).

Conclusion

Healthcare costs following a HF are high relative to the gross domestic product per capita and per capita spending on health in SA. As the population ages, this significant economic burden to the health system will increase.

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References

  1. Kanis JA, Oden A, Johnell O et al (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12(5):417–427

    Article  CAS  PubMed  Google Scholar 

  2. Lorentzon M, Johansson H, Harvey NC et al (2021) Osteoporosis and fractures in women: the burden of disease. Climacteric:1–7

  3. Paruk F, Matthews G, Gregson CL et al (2020) Hip fractures in South Africa: mortality outcomes over 12 months post-fracture. Arch Osteoporos 15(1):76

    Article  PubMed  Google Scholar 

  4. Conradie M, Conradie MM, Scher AT et al (2015) Vertebral fracture prevalence in black and white South African women. Arch Osteoporos 10:203

    Article  PubMed  Google Scholar 

  5. Paruk F, Matthews G, Cassim B (2017) Osteoporotic hip fractures in Black South Africans: a regional study. Arch Osteoporos 12(1):107

    Article  CAS  PubMed  Google Scholar 

  6. Hawley S, Dela S, Burton A et al (2022) Incidence and number of fragility fractures of the hip in South Africa: estimated projections from 2020 to 2050. Osteoporos Int

  7. United Nations Department of Economic and Social Affairs Population Division (2019) World Population Prospects 2019, custom data acquired via website

  8. Salami D, Shaaban AN, Oliveira Martins MDR (2019) Africa rising, a narrative for life expectancy gains? Evidence from a health production function. Ann Glob. Health 85(1)

  9. United Nations Department of Economic and Social Affairs Population Division (2019) World population prospects 2019

  10. Dela SS, Paruk F, Brown SL et al (2020) Ethnic and gender-specific incidence rates for hip fractures in South Africa: a multi-centre study. Bone 133:115253

    Article  CAS  PubMed  Google Scholar 

  11. Statistics South Africa (2020) General household survey 2019. Statistics South Africa, Pretoria, p 113

    Google Scholar 

  12. Potter S, Davies C, Davies G et al (2020) The use of micro-costing in economic analyses of surgical interventions: a systematic review. Health Econ Rev 10(1):3

    Article  PubMed  PubMed Central  Google Scholar 

  13. Drummond MF, Sculpher MJ, Claxton K et al (2015) Methods for the economic evaluation of health care programmes. Oxford university press

    Google Scholar 

  14. Statistics South Africa (2016) Community survey 2016, Statistical release P0301

  15. Republic of South Africa Department of Public Service and Administration (DPSA) (2019) Salary scales. DPSA

  16. KwaZulu-Natal Department of Health (KZN DoH) (2020) Hospital Fees Manual Republic of South Africa: KZN DoH

  17. Glynn J, Hollingworth W, Bhimjiyani A et al (2020) How does deprivation influence secondary care costs after hip fracture? Osteoporos Int 31(8):1573–1585

    Article  CAS  PubMed  Google Scholar 

  18. Lambrelli D, Burge R, Raluy-Callado M et al (2014) Retrospective database study to assess the economic impact of hip fracture in the United Kingdom. J Med Econ 17(11):817–825

    Article  PubMed  Google Scholar 

  19. Leal J, Gray AM, Prieto-Alhambra D et al (2016) Impact of hip fracture on hospital care costs: a population-based study. Osteoporos Int 27(2):549–558

    Article  CAS  PubMed  Google Scholar 

  20. Kanters TA, van de Ree CLP, de Jongh MAC et al (2020) Burden of illness of hip fractures in elderly Dutch patients. Arch of Osteopo 15(1):11

    Article  CAS  Google Scholar 

  21. Jones AM (2010) Models for health care University of York, Centre for Health Economics

  22. World Bank (2020) World development indicators 2020, in GDP per capita, PPP (current international $) - South Africa. The World Bank

  23. World Bank (2018) World development indicators 2018, in Current health expenditure per capita, PPP (current international $) - South Africa. The World Bank

  24. Sekeitto AR, Aden AA (2021) Costing total hip arthroplasty in a South African state tertiary hospital. S Afr Med J 111(3):250–254

    Article  CAS  PubMed  Google Scholar 

  25. Ramjee S (2013) Comparing the cost of delivering hospital services across the public and private sectors in South Africa. University of Cape Town, The Hospital Association of South Africa

    Google Scholar 

  26. Matizirofa L, Chikobvu D (2021) Analysing and quantifying the effect of predictors of stroke direct costs in South Africa using quantile regression. BMC Public Health 21(1):1560

    Article  PubMed  PubMed Central  Google Scholar 

  27. Williamson S, Landeiro F, McConnell T et al (2017) Costs of fragility hip fractures globally: a systematic review and meta-regression analysis. Osteoporos Int 28(10):2791–2800

    Article  CAS  PubMed  Google Scholar 

  28. Kanis JA, Norton N, Harvey NC et al (2021) SCOPE 2021: a new scorecard for osteoporosis in Europe. Arch of Osteopo 16(1):82

    Article  Google Scholar 

  29. Talevski J, Sanders K, Lal A et al (2022) A micro-costing analysis of post-fracture care pathways: results from the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS). Osteopo Int 33(9):1895–1907

    Article  CAS  Google Scholar 

  30. Competition Commission of South Africa (2019) Health market inquiry final findings and recommendations report. Government Gazette No. 42861

  31. World Health Organization (2021) Tracking universal health coverage: 2021 global monitoring report. World Health Organization

  32. de Villiers K (2021) Bridging the health inequality gap: an examination of South Africa’s social innovation in health landscape. Infect Dis Poverty 10(1):19

    Article  PubMed  PubMed Central  Google Scholar 

  33. Veronese N, Kolk H, Maggi S (2021) Epidemiology of fragility fractures and social impact, in orthogeriatrics: the management of older patients with fragility fractures. In: Falaschi P, Marsh D (eds) . Springer Copyright 2021, Cham (CH), pp 19–34

    Google Scholar 

  34. Jim A (2010) Health seeking behaviours in South Africa: a household perspective using the general households survey of 2007. University of the Western Cape

    Google Scholar 

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Funding

This work was supported by the National Institute for Health Research (NIHR) (using the UK’s Official Development Assistance (ODA) Funding) and the Wellcome (217135/Z/19/Z; 2020-25) under the NIHR-Wellcome Partnership for Global Health Research. The views expressed are those of the authors and not necessarily those of the Wellcome, the NIHR, or the Department of Health and Social Care. FP was funded through an unrestricted educational grant from Servier® PTY (LTD) (2010) and the University of KwaZulu-Natal competitive grant (2010). For the purpose of Open Access, the author has applied a CC-BY public copyright licence to the Author Accepted Manuscript version arising from this submission.

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Authors and Affiliations

  1. Health Economic and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK

    N. Mafirakureva

  2. Department of Rheumatology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

    F. Paruk

  3. Department of Geriatrics, School of Clinical Medicine, University of Kwa Zulu-Natal, Durban, South Africa

    B. Cassim

  4. Division of Orthopaedics, University of Witwatersrand, Johannesburg, South Africa

    M. Lukhele

  5. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

    N. Mafirakureva & C.L. Gregson

  6. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

    S.M. Noble

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  1. N. Mafirakureva
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Correspondence to N. Mafirakureva.

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Nyashadzaishe Mafirakureva and Farhanah Paruk are the joint first authors.

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Mafirakureva, N., Paruk, F., Cassim, B. et al. The healthcare system costs of hip fracture care in South Africa. Osteoporos Int 34, 803–813 (2023). https://doi.org/10.1007/s00198-022-06664-9

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  • DOI: https://doi.org/10.1007/s00198-022-06664-9

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