HIP FRACTURES DRIVE UP HEALTHCARE COSTS IN A SPEEDY PACE
Hip fractures account for the majority of osteoporotic fragility fractures and for over 40% of the estimated burden of osteoporosis worldwide. In 2010, there were an estimated 600,000 incident hip fractures in the European Union, costing €20 billion and accounting for 54% of the total costs of osteoporosis (1).
As already dealt with in a previous SAFEHIP newsletter article, many studies, reports and analyses of future hip fracture projections reach the same conclusion that the changing demographics will make the global hip fracture rates increase remarkably towards the year 2050.
Next to the human costs, hip fractures put a heavy burden on health economy, as hospital expenditures, social care and rehabilitation drive up costs excessively. It is very important to be aware of these costs, as the awareness is key to investment and disinvestment decisions regarding new osteoporosis and hip fracture prevention interventions. In many cases, if not all, the decisions are driven by profound cost-effectiveness analyses, in which the long-term expenditure of hip fractures plays a vital role.
In the UK, hip fracture is associated with a total cost to health and social services of over £1 billion per year. This one injury carries a total cost equivalent of approximately 1% of the whole National Health Service budget (1). This is, in part, due to patients remaining in hospital for a number of weeks, leading to one and a half million hospital bed days being used each year (2).
Unfortunately, the current population and incidence projections developed by the National Hip Fracture Database, suggested in 2010 that by 2020 the cost of managing a hip fracture will rise by 50% to £3 billion per year in the UK (3).
In 2016, a population-based study on the impact of hip fracture on hospital care costs in the UK was published, enrolling no less than 33,152 hip fracture patients.
The study proved that hospital costs following hip fracture are high and mostly occur in the first year after the index hip fracture. Estimated costs to the hospital services in the year of the fracture are £1131 million a year. Projections may indicate the hip fracture incidence to rise by 32% in 2025, and if so, the hospital costs within the year of the fracture will increase to £1493 million a year.
Experiencing a second hip fracture after the index fracture accounted for much of the increase in costs. Having a second hip fracture within the same year as the primary one was associated with an additional £9198 expenditure in hospitalisation costs.
In general, hospital costs are found to be high in the first 6 months after a hip fracture, falling thereafter to levels of expenditure similar to the year before fracture. The same cost profile was observed in patients with a second hip fracture; however, initial admission costs were higher in the second fracture compared to the first.
Comparing costs before and after hip fracture showed these to gradually increase in the last 6 months prior to fracture, suggesting a worsening in health that may be associated with the risk of fracture.
A study comparing time trends in hip fracture rates in five European countries reported that rates in the UK increased by 0.7% during 2005 – 2009 (19). If this holds true, the results could be devastating in the UK. Even with constant hip fracture rates, the UK will see a 78% increased hip fracture burden with their anticipated population growth of 65% by 2040 (4).
A potential cost-effective approach is through the implementation of coordinated approaches to fracture prevention such as fracture liaison services (FLS). The Glasgow Fracture Liaison Service reported that for every 1000 patients with a fragility fracture assessed by FLS, 18 fragility fractures (including 11 hip fractures) were prevented. This equates to potential savings of £120,604 per 1000 patients from the hip fractures averted alone (5).
In Germany, the incidence of hip fractures is estimated at 125,000 cases per year and costs related to hip fractures are estimated to be 2.8 billion EURO per year (6).
Hip fracture rates in women in Western Germany declined only by 0.2% per year from 1995 to 2010, whereas a current study demonstrates that a decline of 1.1% per year is required to reduce the impact of the growing population in Germany (7).
NORWAY AND USA
An annual decline in hip fracture rates of 1,1 - 2,2% until 2040 is required to counteract the effects of a growing elderly population on the future burden of hip fractures in countries like Norway and USA.
With a decline of 2.5% per year, as reported between 1995 and 2005, the impact of a growing elderly population in the USA is counteracted. However, this requires that rates should decline from 84 per 10,000 in 2010 to 45 per 10,000 in 2040 and a decrease of this size is highly unlikely.
The population of people aged 65 years and older in Norway is expected to increase by 85% between 2008 and 2040. Given no decline in age-specific rates, the number of hip fractures in Norway will increase by 92% by 2040. On the other hand, if Norwegian age-specific hip fracture rates continue declining at constant speed, the number of hip fractures will instead increase by 22% by 2040. The continued decline scenario implies that the hip fracture rates will have to decline by 37% (1.4% annually) from 155 per 10,000 in 2008 to 98 per 10,000 in 2040 (8).
Hip fractures including rehabilitation cost 2.3 billion Swedish crones annually in Sweden (9).
As the annual number of hip fractures in Sweden will have doubled from approximately 16,000 in 2002 to around 30,000 in the year 2050, it must be expected that the hip fracture costs will escalate dramatically also (10).
Data on incidence rate of hip fracture obtained from 9 Asian countries (China, Hong Kong, India, Japan, Korea, Malaysia, Singapore, Taiwan and Thailand) shows that
the direct cost of hip fracture will increase from 9.5 billion USD in 2018 to 15 billion USD in 2050, resulting in a 1.59-fold increase.
A 2–3% decrease in incidence rate of hip fracture annually is required to keep the total number of hip fracture constant over time.
The increase in direct medical cost in 2050 is lower than the increase in number of hip fractures in 2050. This is due to the fact that the direct medical costs of hip fracture for the countries with the highest increase in the number of hip fracture (China and India) are generally lower, whereas Japan, the country with the highest direct medical cost, has the lowest increment in the number of hip fractures by 2050. It should be noted that given the burgeoning economic development in China and India, it is expected that the direct medical cost will increase over time. Thus, the projected direct cost from these countries would be underestimated (11).
ACTIONS IS NEEDED
With the projected hip fracture rates and the incremental costs, there is no doubt that the main target must be to reduce the annual incidence of hip fracture by a minimum of 1,1–3% each year, in order to stabilise the total number of hip fractures over time. To achieve this goal, various stakeholders, including patients, patient families, healthcare professionals, and governments, need to be actively involved so that action can be taken to prevent hip fracture related costs from escalating dramatically over the coming years.
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