ต้นทุน-ประสิทธิผลของโครงการรู้ทัน..กันหักซ้ำ ในผู้ป่วยกระดูกสะโพกหัก โรงพยาบาลเลิดสิน

Jutatip Artheeraphan; Attasit Srisubat; Chitawee Jiamton; Chatravee Jindapol; Ramonpawee Boonyai; Waranya Tasomboon; Suwipa Udomporn

Authors

Jutatip Artheeraphan Lerdsin Hospital, Department of Medical Services, Ministry of Public Health
Attasit Srisubat Institute of Medical Research and Technology Assessment, Department of Medical Services, Ministry of Public Health
Chitawee Jiamton Lerdsin Hospital, Department of Medical Services, Ministry of Public Health
Chatravee Jindapol Lerdsin Hospital, Department of Medical Services, Ministry of Public Health
Ramonpawee Boonyai Lerdsin Hospital, Department of Medical Services, Ministry of Public Health
Waranya Tasomboon Lerdsin Hospital, Department of Medical Services, Ministry of Public Health
Suwipa Udomporn Lerdsin Hospital, Department of Medical Services, Ministry of Public Health

Keywords:

economic evaluation, cost-effectiveness, refracture prevention, fractured hip patients

Abstract

Background and Rationale: Hip fracture in the elderly is a common problem in all countries worldwide and tends to increase every year along with the number of older adults. Treatment and rehabilitation of the patients take a long time, resulting in financial burdens for each country. The repeated fractures rate within 1 year was 2-11%. The current treatment of hip fracture patients was to cure and focus on the prevention of recurrent fractures. Therefore, the Refracture Prevention Program with multidisciplinary care was created. The purpose of this study was to investigate the cost-effectiveness of patients with fractured hips in Refracture Prevention Program compared with traditional treatment in healthcare provider’s aspect. Methodology: A prospective and retrospective study was conducted in 2 sample groups, with the control group receiving traditional treatment and the experimental group in the Refracture Prevention Program. Data were collected from 130 fractured hip patients of each group starting from admission day in Lerdsin Hospital for up to 1 year. The economic evaluation used a decision tree to show an incremental cost and effectiveness of each group. Results: The refracture prevention group had statistically significant higher quality-adjust life years (QALYs) than the traditional group (p < 0.05) and the program could prevent refracture better than the traditional group. Refracture rate per year reduced from 6.27% to 4.29%. The unit cost of hip fracture treatment in the Refracture Prevention Program was THB 139,504, while the traditional group was THB 150,720. The QALYs of the refracture prevention group was 0.6023, while the traditional group was 0.5106. New intervention was dominant: treatment under the Refracture Prevention Program was cheaper and better than traditional treatment. Conclusion and Discussion: The model of care for elderly patients with hip fracture should be the fracture liaison service model, with multidisciplinary cooperation and prevention of recurrent fracture risk factors. During the first year, there were 3 main costs of the program (operation, osteoporosis treatment and fall prevention) compared to only surgical treatment cost in the traditional treatment. Further study should be the long-term follow-up of the project. Besides the costing perspective, there should be a study on the financial burden of Thailand, in order to know the magnitude of the problem for future planning.

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