BACKGROUND:The economic burden associated with hip fractures calls for the investigation of innovative new cost-utility forms of organisation and integration of services for these patients. OBJECTIVE:To carry out a cost-utility analysis integrating epidemiological and economic aspects for hip fracture patients treated within a comprehensive orthogeriatric model (COGM) of care, as compared with standard of care model (SOCM). DESIGN:A demonstration study conducted in a major tertiary medical centre, operating both a COGM ward and standard orthopaedic and rehabilitation wards. METHODS:Data was collected on the clinical outcomes and health care costs of the two different treatment modalities, in order to calculate the absolute cost and disability-adjusted life years (DALY) ratio. RESULTS:The COGM model used 23% fewer resources per patient ($14,919 vs. $19,363) than the SOCM model and to avert 0.226 additional DALY per patient, mainly as a result of lower 1-year mortality rates among COGM patients (14.8% vs. 17.3%). CONCLUSION:A comprehensive ortho-geriatric care modality is more cost-effective, providing additional quality-adjusted life years (QALY) while using fewer resources compared with standard of care approach. The results should assist health policy-makers in optimising healthcare use and healthcare planning.

译文

背景:与髋部骨折相关的经济负担要求研究创新的新型成本效用形式的组织和针对这些患者的服务整合。
目的:进行成本效用分析,将在综合老年医学模型(COGM)中接受治疗的髋部骨折患者的流行病学和经济因素与标准治疗模型(SOCM)进行比较。
设计:在一家主要的三级医疗中心进行的一项示范研究,既经营COGM病房,又经营标准的骨科和康复病房。
方法:收集有关两种不同治疗方式的临床结局和医疗保健费用的数据,以计算绝对费用和残疾调整生命年(DALY)比率。
结果:COGM模型比SOCM模型使用的每位患者资源减少了23%($ 14,919比$ 19,363),并且避免了每位患者增加0.226 DALY,这主要是由于COGM患者的1年死亡率降低了(14.8%vs. 17.3%)。
结论:与标准的护理方法相比,综合的老年病护理方式更具成本效益,可提供额外的质量调整生命年(QALY),同时使用更少的资源。结果应有助于卫生政策制定者优化医疗保健使用和医疗保健计划。

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