The healthcare system costs of hip fracture care in South Africa

Nyashadzaishe Mafirakureva; Farhanah Paruk; Bilkish Cassim; Mkhululi Lukhele; Celia L Gregson; Sian M Noble

doi:10.1007/s00198-022-06664-9

The healthcare system costs of hip fracture care in South Africa

Nyashadzaishe Mafirakureva^*, Farhanah Paruk, Bilkish Cassim, Mkhululi Lukhele, Celia L Gregson, Sian M Noble

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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Abstract

Purpose
We estimated direct healthcare costs of hip fracture (HF) management in the South African (SA) public healthcare system.

Methods
We conducted a micro-costing study to estimate costs per patient treated for HF in five regional public sector hospitals in KwaZulu-Natal (KZN), SA. Two hundred consecutive, consenting patients presenting with a fragility HF were prospectively enrolled. Resource use including staff time, consumables, laboratory investigations, radiographs, operating theatre time, surgical implants, medicines, and inpatient days were collected from presentation to discharge. Counts of resources used were multiplied by unit costs, estimated from KZN Department of Health hospital fees manual 2019/20, in local currency (South African Rand, ZAR), and converted to 2020 US$ prices. Generalised linear models estimated total covariate adjusted costs and cost predictors.

Results
The mean unadjusted cost for HF management was US$6,935 (95% CI; US$6,401-7,620) [ZAR114,179 (95% CI; ZAR105,468-125,335)]. The major cost driver was orthopaedics/surgical ward costs US$5,904 (95% CI; 5,408-6,535), contributing to 85% of total cost. The covariate adjusted cost for HF management was US$6,922 (95% CI; US$6,743-7,118) [ZAR113,976 (95% CI; ZAR111,031-117,197)]. After covariate adjustment, total costs were higher in patients operated under general anaesthesia [US$7,251 (95% CI; US$6,506-7,901)] compared to surgery under spinal anaesthesia US$6,880 (95% CI; US$6,685-7,092) and no surgery US$7,032 (95% CI; US$6,454 -7,651).

Conclusion
Healthcare costs following a HF are high relative to the gross domestic product per capita, and per capita spending on health in SA. As the population ages, this significant economic burden to the health system will increase.

Original language	English
Pages (from-to)	803–813
Number of pages	11
Journal	Osteoporosis International
Volume	34
Issue number	4
Early online date	27 Jan 2023
DOIs	https://doi.org/10.1007/s00198-022-06664-9
Publication status	E-pub ahead of print - 27 Jan 2023

Bibliographical note

Funding Information:
This work was supported by the National Institute for Health Research (NIHR) (using the UK’s Official Development Assistance (ODA) Funding) and the Wellcome (217135/Z/19/Z; 2020-25) under the NIHR-Wellcome Partnership for Global Health Research. The views expressed are those of the authors and not necessarily those of the Wellcome, the NIHR, or the Department of Health and Social Care. FP was funded through an unrestricted educational grant from Servier® PTY (LTD) (2010) and the University of KwaZulu-Natal competitive grant (2010). For the purpose of Open Access, the author has applied a CC-BY public copyright licence to the Author Accepted Manuscript version arising from this submission.

Publisher Copyright:
© 2023, International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.

Research Groups and Themes

HEHP@Bristol

Keywords

Costs
health economics
hip fracture
economic burden
osteoporosis
South Africa

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@article{365aa7f7b89147e588e73fefb37fa2f7,

title = "The healthcare system costs of hip fracture care in South Africa",

abstract = "Purpose We estimated direct healthcare costs of hip fracture (HF) management in the South African (SA) public healthcare system.MethodsWe conducted a micro-costing study to estimate costs per patient treated for HF in five regional public sector hospitals in KwaZulu-Natal (KZN), SA. Two hundred consecutive, consenting patients presenting with a fragility HF were prospectively enrolled. Resource use including staff time, consumables, laboratory investigations, radiographs, operating theatre time, surgical implants, medicines, and inpatient days were collected from presentation to discharge. Counts of resources used were multiplied by unit costs, estimated from KZN Department of Health hospital fees manual 2019/20, in local currency (South African Rand, ZAR), and converted to 2020 US$ prices. Generalised linear models estimated total covariate adjusted costs and cost predictors.ResultsThe mean unadjusted cost for HF management was US$6,935 (95% CI; US$6,401-7,620) [ZAR114,179 (95% CI; ZAR105,468-125,335)]. The major cost driver was orthopaedics/surgical ward costs US$5,904 (95% CI; 5,408-6,535), contributing to 85% of total cost. The covariate adjusted cost for HF management was US$6,922 (95% CI; US$6,743-7,118) [ZAR113,976 (95% CI; ZAR111,031-117,197)]. After covariate adjustment, total costs were higher in patients operated under general anaesthesia [US$7,251 (95% CI; US$6,506-7,901)] compared to surgery under spinal anaesthesia US$6,880 (95% CI; US$6,685-7,092) and no surgery US$7,032 (95% CI; US$6,454 -7,651). ConclusionHealthcare costs following a HF are high relative to the gross domestic product per capita, and per capita spending on health in SA. As the population ages, this significant economic burden to the health system will increase. ",

keywords = "Costs, health economics, hip fracture, economic burden, osteoporosis, South Africa",

author = "Nyashadzaishe Mafirakureva and Farhanah Paruk and Bilkish Cassim and Mkhululi Lukhele and Gregson, {Celia L} and Noble, {Sian M}",

note = "Funding Information: This work was supported by the National Institute for Health Research (NIHR) (using the UK{\textquoteright}s Official Development Assistance (ODA) Funding) and the Wellcome (217135/Z/19/Z; 2020-25) under the NIHR-Wellcome Partnership for Global Health Research. The views expressed are those of the authors and not necessarily those of the Wellcome, the NIHR, or the Department of Health and Social Care. FP was funded through an unrestricted educational grant from Servier{\textregistered} PTY (LTD) (2010) and the University of KwaZulu-Natal competitive grant (2010). For the purpose of Open Access, the author has applied a CC-BY public copyright licence to the Author Accepted Manuscript version arising from this submission. Publisher Copyright: {\textcopyright} 2023, International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.",

year = "2023",

month = jan,

day = "27",

doi = "10.1007/s00198-022-06664-9",

language = "English",

volume = "34",

pages = "803–813 ",

journal = "Osteoporosis International",

issn = "0937-941X",

publisher = "Springer London",

number = "4",

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TY - JOUR

T1 - The healthcare system costs of hip fracture care in South Africa

AU - Mafirakureva, Nyashadzaishe

AU - Paruk, Farhanah

AU - Cassim, Bilkish

AU - Lukhele, Mkhululi

AU - Gregson, Celia L

AU - Noble, Sian M

N1 - Funding Information: This work was supported by the National Institute for Health Research (NIHR) (using the UK’s Official Development Assistance (ODA) Funding) and the Wellcome (217135/Z/19/Z; 2020-25) under the NIHR-Wellcome Partnership for Global Health Research. The views expressed are those of the authors and not necessarily those of the Wellcome, the NIHR, or the Department of Health and Social Care. FP was funded through an unrestricted educational grant from Servier® PTY (LTD) (2010) and the University of KwaZulu-Natal competitive grant (2010). For the purpose of Open Access, the author has applied a CC-BY public copyright licence to the Author Accepted Manuscript version arising from this submission. Publisher Copyright: © 2023, International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.

PY - 2023/1/27

Y1 - 2023/1/27

N2 - Purpose We estimated direct healthcare costs of hip fracture (HF) management in the South African (SA) public healthcare system.MethodsWe conducted a micro-costing study to estimate costs per patient treated for HF in five regional public sector hospitals in KwaZulu-Natal (KZN), SA. Two hundred consecutive, consenting patients presenting with a fragility HF were prospectively enrolled. Resource use including staff time, consumables, laboratory investigations, radiographs, operating theatre time, surgical implants, medicines, and inpatient days were collected from presentation to discharge. Counts of resources used were multiplied by unit costs, estimated from KZN Department of Health hospital fees manual 2019/20, in local currency (South African Rand, ZAR), and converted to 2020 US$ prices. Generalised linear models estimated total covariate adjusted costs and cost predictors.ResultsThe mean unadjusted cost for HF management was US$6,935 (95% CI; US$6,401-7,620) [ZAR114,179 (95% CI; ZAR105,468-125,335)]. The major cost driver was orthopaedics/surgical ward costs US$5,904 (95% CI; 5,408-6,535), contributing to 85% of total cost. The covariate adjusted cost for HF management was US$6,922 (95% CI; US$6,743-7,118) [ZAR113,976 (95% CI; ZAR111,031-117,197)]. After covariate adjustment, total costs were higher in patients operated under general anaesthesia [US$7,251 (95% CI; US$6,506-7,901)] compared to surgery under spinal anaesthesia US$6,880 (95% CI; US$6,685-7,092) and no surgery US$7,032 (95% CI; US$6,454 -7,651). ConclusionHealthcare costs following a HF are high relative to the gross domestic product per capita, and per capita spending on health in SA. As the population ages, this significant economic burden to the health system will increase.

AB - Purpose We estimated direct healthcare costs of hip fracture (HF) management in the South African (SA) public healthcare system.MethodsWe conducted a micro-costing study to estimate costs per patient treated for HF in five regional public sector hospitals in KwaZulu-Natal (KZN), SA. Two hundred consecutive, consenting patients presenting with a fragility HF were prospectively enrolled. Resource use including staff time, consumables, laboratory investigations, radiographs, operating theatre time, surgical implants, medicines, and inpatient days were collected from presentation to discharge. Counts of resources used were multiplied by unit costs, estimated from KZN Department of Health hospital fees manual 2019/20, in local currency (South African Rand, ZAR), and converted to 2020 US$ prices. Generalised linear models estimated total covariate adjusted costs and cost predictors.ResultsThe mean unadjusted cost for HF management was US$6,935 (95% CI; US$6,401-7,620) [ZAR114,179 (95% CI; ZAR105,468-125,335)]. The major cost driver was orthopaedics/surgical ward costs US$5,904 (95% CI; 5,408-6,535), contributing to 85% of total cost. The covariate adjusted cost for HF management was US$6,922 (95% CI; US$6,743-7,118) [ZAR113,976 (95% CI; ZAR111,031-117,197)]. After covariate adjustment, total costs were higher in patients operated under general anaesthesia [US$7,251 (95% CI; US$6,506-7,901)] compared to surgery under spinal anaesthesia US$6,880 (95% CI; US$6,685-7,092) and no surgery US$7,032 (95% CI; US$6,454 -7,651). ConclusionHealthcare costs following a HF are high relative to the gross domestic product per capita, and per capita spending on health in SA. As the population ages, this significant economic burden to the health system will increase.

KW - Costs

KW - health economics

KW - hip fracture

KW - economic burden

KW - osteoporosis

KW - South Africa

UR - https://rdcu.be/c4jKm

U2 - 10.1007/s00198-022-06664-9

DO - 10.1007/s00198-022-06664-9

M3 - Article (Academic Journal)

C2 - 36705682

SN - 0937-941X

VL - 34

SP - 803

EP - 813

JO - Osteoporosis International

JF - Osteoporosis International

IS - 4

ER -

The healthcare system costs of hip fracture care in South Africa

Abstract

Bibliographical note

Research Groups and Themes

Keywords

Access to Document

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Incidence and number of fragility fractures of the hip in South Africa: estimated projections from 2020 to 2050

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