Cost-effectiveness of referrals to high-volume hospitals: an analysis based on a probabilistic Markov model for hip fracture surgeries.

Previous studies suggest that German hospitals that perform a high volume of hip fracture surgeries have a lower mortality rate and shorter length of stay than low-volume hospitals. The goal of this paper was to determine the long-term cost-effectiveness (over 20 years) of referring hip fracture surgeries to high-volume hospitals, based on data from previous studies. From a societal perspective, the cost-effectiveness ratio was 15,530 Euro per QALY (quality-adjusted life year) (95% confidence interval 9,864-33,048 Euro), while total annual costs to the statutory health insurance amounted up to 19.6 million Euro. The referral of hip fracture surgeries to high-volume hospitals is thus likely to be cost-effective in Germany.