Up-to-date costs of hip fracture care in England and Wales identify substantial variation between hospitals; the REDUCE Study

Background: Accurate and up-to-date costing of key healthcare indictors is important to inform cost-effectiveness analyses underpinning health policy decisions.

Objectives: To calculate NHS inpatient care costs in the first 120 days and the year following an index hip fracture, and understand regional variations in these costs.

Methods: The REDUCE study (REducing unwarranted variation in the Delivery of high qUality hip fraCture services) included all hip fracture admissions in England and Wales between 01/04/2016 and 31/03/2019, retrieving finished consultant episode (FCE) records from English Hospital Episodes Statistics and Patient Episode Database Wales in the year before and after an index fracture date. Healthcare Resource Groups (HRGs) were derived for all FCEs via the HRG4+2018/19 Reference Costs Grouper, and FCEs were valued using 2019–2020 reference costs imputing costs for codes invalid for grouping. Patient inpatient costs were estimated for the 120-days and 1-year before and after fracture and compared by hospital and region.

Results: Overall 178,757 patients in England and Wales had 288,032 FCEs in the year before and 647,257 in the year after an index hip fracture. Costs for 32,721 FCEs (3.5%) were imputed. Inpatient costs after index fracture were, on average, £14,465 per patient (95%CI £14,424 to £14,506) in the year after hip fracture; 86.7% of these costs occur within the first 120 days (mean 120 days cost=£12,547; 95%CI £12,516 to £12,578). One-year costs were higher in Wales (mean cost=£17,596; 95%CI £17,344 to £17,848) than in England (mean cost=£14,272; 95%CI £14,231 to £14,312). Mean costs varied by region, from average £13,580 (95%CI 13,442 to 13,718) in the East Midlands to £15,960 (95%CI £15,811 to £16,110) in London. Average costs varied substantially between hospitals from £10,787 to £22,721. The mean inpatient cost in the year prior to the index hip fracture was £2,560 (95%CI £2,535 to £2,585), hence the incremental cost after the hip fracture was on average £11,905 per patient (95%CI 11,862 to 11,949). According to our estimates, the annual NHS inpatient burden of hip fracture was £639 million to £664 million in England and £50 million to £55 million in Wales from 2016/7 to 2018/9.

Conclusion: Inpatient costs in the year following a hip fracture are higher than previously reported and vary considerably between hospitals and regions within England and Wales. Such between-hospital variability is difficult to justify clinically and requires further investigation of organisational cost-drivers.