Direct medical costs of interprosthetic femoral fracture treatment: A cohort analysis.

Introduction: Periprosthetic femoral fractures (PPFs) represent a challenging clinical problem with a fast-rising incidence. Interprosthetic fractures (IPFs) represent one of its most difficult variants. There is a paucity of data regarding the financial burden of PPFs, and none for IPFs. This study aims to estimate the direct medical cost of the surgical treatment of IPFs in NHS, and analyse the factors influencing this when using different methods of surgical treatment.
Methods: A cohort of patients with IPFs treated in a single academic unit over a period of 8-years with different surgical methods was studied. In-hospital details, as well as outpatient follow-up data, were gathered relevant to their clinical and radiological outcome until discharge. Local and national NHS data were acquired from the financial department, as well as industry-related resources. The economic analysis was structured as a cost identification analysis (CIA) of the overall cohort, but also as a comparative best-case scenario (uncomplicated course till discharge) comparison between the 3 main different management strategies (a) revision arthroplasty (RTHA), b) plate fixation (ORIF), c) combination of implants (COMBO).
Results: Data from 28 patients (22 females) with IPFs were analysed with a median age of 78.4 years. The overall direct medical cost of treating this cohort of patients was £468,330, with a median of £15.625 (range £10,128 to 33,060). Comparing the three different surgical modalities, the median cost in groups a, b, and c was £20,793 (range £12,110 to £24,116), £12,979 (range £10,128 to £20,555), and £22,316 (range £10,938 to £23,081) respectively. In all groups, the 2/3 of the identified costs were relevant to the inpatient stay. Transfusions were the highest (3 units of cRBC on average) to the patients that received a revision THA vs the other two groups (p=0.022). There was statistically significant higher mean overall cost between the RTHA and the ORIF groups (£19,453 vs. £14,201, p=0.0242), but not when compared with the COMBO cases (£19,453 vs. £18,788, p=0.86).
Conclusion: The first cost identification study and "best case scenario" comparative analysis for IPFs demonstrated a significant overall direct medical cost, when managing these complex fractures with variable contemporary techniques. Evidence based reimbursement strategies should be developed to allow the sustainability of the clinical service we offer in this challenging patient population.
Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest regarding the content of this manuscript.
(Copyright © 2021. Published by Elsevier Ltd.)