Service use and costs of incident femoral fractures in nursing home residents in Germany: the Bavarian Fall and Fracture Prevention Project (BF2P2).

OBJECTIVES: Hip fractures are one of the most costly consequences of falls in the elderly. Despite their increased risk of falls and fractures, nursing home residents are often neglected in service utilization and costing studies. The purpose of this study was to determine service use, initial and long-term direct costs of incident femoral fractures in nursing home residents 65 years or older in Germany.
DESIGN: An incidence-based, bottom-up cost-of-illness study aiming at measuring fracture-related direct costs from a payer perspective was conducted.
SETTING: Nursing homes PARTICIPANTS: The retrospective dataset included all insurants of a sickness fund (Allgemeine Ortskrankenkasse Bavaria), who were 65 years or older, resided in a nursing home, and had a level of care of at least one in the statutory long-term care insurance (n = 60,091). MEASUREMENTS: Incident femoral fractures (ICD-10, S72) in 2006 were followed until the end of 2008, incorporating service use and costs of inpatient care (up to 12 months after the initial hospitalization episode), nursing home care (until death or the end of 2008), and ambulatory care (pharmaceuticals, nonphysician providers, and medical supply within 3 months after the initial hospitalization episode). Additional costs for nursing home and ambulatory care were determined with a before/after design. Costs beyond the year 2006 were discounted with a rate of 5%. Sensitivity analyses on key parameters were performed.
RESULTS: Overall mean direct costs of 9488 USD (SD ± 4453 USD, 2006) occurred for incident femoral fractures (n = 1525). This included inpatient care (90.2%), additional costs for nursing home care (7.1%), and ambulatory care (2.7%). Eighty-seven percent of the costs occurred for the initial hospitalization episode and 13% for long-term costs. After the index admission, 12.1% were admitted to a rehabilitation facility, 4.1% were rehospitalized within a year, and in 17.7% the level of care increased within 90 days after the end of the initial hospital episode. The share of residents with incident femoral fractures rehospitalized was significantly higher and costs for nonphysician providers were significantly lower for male residents.
CONCLUSION: Residents with femoral fractures used a wide range of health services. Our study underestimates the true costs to society in Germany. Efforts should be directed to economic evaluations of fall-prevention programs aiming at reducing fall-related fractures including femoral fractures.