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The healthcare system costs of hip fracture care in South Africa

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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.


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


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.


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).


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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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).

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