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Costs of fragility hip fractures globally: a systematic review and meta-regression analysis

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Abstract

Purpose This study was conducted in order to systematically review the costs of hip fractures globally and identify drivers of differences in costs. Methods A systematic review was conducted to identify studies reporting patient level fragility hip fracture costs between 1990 and 2015. We extracted data on the participants and costs from these studies. Cost data concerning the index hospitalisation were pooled, and a meta-regression was used to examine its potential drivers. We also pooled data on the first-year costs following hip fracture and considered healthcare, social care as well as other cost categories if reported by studies. Results One hundred and thirteen studies reported costs of hip fracture based on patient level data. Patients developing complications as well as patients enrolled in intervention arms of comparative studies were found to have significantly higher costs compared to the controls. The pooled estimate of the cost for the index hospitalisation was $10,075. Health and social care costs at 12 months were $43,669 with inpatient costs being their major driver. Meta-regression analysis identified age, gender and geographic region as being significantly associated with the differences in costs for the index hospitalisation. Conclusion Hip fracture poses a significant economic burden and variation exists in their costs across different regions. We found that there was a considerable variation across studies in terms of study design, methodology, follow-up period, costs considered and results reported that highlights the need for more standardisation in this area of research.

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Acknowledgements

This project was funded by the NIHR Health Services and Delivery Research programme (project number 11/1023/01). Support was received from the Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford. S.W. received support from NIHR as Academic Clinical Fellow in Public Health.

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR programme, NIHR, NHS, or the Department of Health.

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Correspondence to J. Leal.

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S.W., F.L., T.M., L.F-S and J.L. report no conflict of interest.

M.K.J. has received in the last 5 years honoraria for travel expenses, speaker fees and/or advisory committees from Lilly UK, Amgen, Servier, Merck, Medtronic, Internis, Consilient Health and Jarrow Formulas. He also serves on the Scientific Committee of the National Osteoporosis Society and International Osteoporosis Foundation.

A.J. has received consultancy, lecture fees and honoraria from Servier, UK Renal Registry, Oxford Craniofacial Unit, IDIAP Jordi Gol and Freshfields Bruckhaus Deringer; has held advisory board positions (which involved receipt of fees) from Anthera Pharmaceuticals, Inc.; and received consortium research grants from ROCHE.

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Williamson, S., Landeiro, F., McConnell, T. et al. Costs of fragility hip fractures globally: a systematic review and meta-regression analysis. Osteoporos Int 28, 2791–2800 (2017). https://doi.org/10.1007/s00198-017-4153-6

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