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
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
Lorentzon M, Johansson H, Harvey NC et al (2021) Osteoporosis and fractures in women: the burden of disease. Climacteric:1–7
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
Conradie M, Conradie MM, Scher AT et al (2015) Vertebral fracture prevalence in black and white South African women. Arch Osteoporos 10:203
Paruk F, Matthews G, Cassim B (2017) Osteoporotic hip fractures in Black South Africans: a regional study. Arch Osteoporos 12(1):107
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
United Nations Department of Economic and Social Affairs Population Division (2019) World Population Prospects 2019, custom data acquired via website
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)
United Nations Department of Economic and Social Affairs Population Division (2019) World population prospects 2019
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
Statistics South Africa (2020) General household survey 2019. Statistics South Africa, Pretoria, p 113
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
Drummond MF, Sculpher MJ, Claxton K et al (2015) Methods for the economic evaluation of health care programmes. Oxford university press
Statistics South Africa (2016) Community survey 2016, Statistical release P0301
Republic of South Africa Department of Public Service and Administration (DPSA) (2019) Salary scales. DPSA
KwaZulu-Natal Department of Health (KZN DoH) (2020) Hospital Fees Manual Republic of South Africa: KZN DoH
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
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
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
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
Jones AM (2010) Models for health care University of York, Centre for Health Economics
World Bank (2020) World development indicators 2020, in GDP per capita, PPP (current international $) - South Africa. The World Bank
World Bank (2018) World development indicators 2018, in Current health expenditure per capita, PPP (current international $) - South Africa. The World Bank
Sekeitto AR, Aden AA (2021) Costing total hip arthroplasty in a South African state tertiary hospital. S Afr Med J 111(3):250–254
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
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
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
Kanis JA, Norton N, Harvey NC et al (2021) SCOPE 2021: a new scorecard for osteoporosis in Europe. Arch of Osteopo 16(1):82
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
Competition Commission of South Africa (2019) Health market inquiry final findings and recommendations report. Government Gazette No. 42861
World Health Organization (2021) Tracking universal health coverage: 2021 global monitoring report. World Health Organization
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
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
Jim A (2010) Health seeking behaviours in South Africa: a household perspective using the general households survey of 2007. University of the Western Cape
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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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