The direct cost of acute hip fracture care in care home residents in the UK

Data on the true acute care costs of hip fractures for patients admitted from care homes are limited. Detailed costing analysis was undertaken for 100 patients. Median cost was A 9,429 pound [a,not sign10,896], increasing to A 14,435 pound [a,not sign16,681], for those requiring an upgrade from residential to nursing home care. Seventy-six percent of costs were attributable to hospital bed days, and therefore, interventions targeted at reducing hospital stay may be cost effective. Previous studies have estimated the costs associated with hip fracture, although these vary widely, and for patients admitted from care homes, who represent a significant fracture burden, there are limited data. The primary aim of this study was to perform a detailed assessment of the direct medical costs incurred and secondly compare this to the actual remuneration received by the hospital. One hundred patients presenting from a care home in 2006 were randomly selected and a detailed case-note costing analysis was undertaken. This cost was then compared to the actual remuneration received by the hospital. Median cost per patient episode was A 9,429 pound [a,not sign10,896] (all patients) range A 4,292-162,324 pound [a,not sign4,960-187,582] (subdivided into hospital bed day costs A 7,129 pound [a,not sign8,238], operative costs A 1,323 pound [a,not sign1,529] and investigation costs A 977 pound [a,not sign1,129]). Twenty-two percent of the patients admitted from a residential home required upgrading to a nursing home. In this group, the median length of stay was 31 days (mean 38, range 10-88) median cost A 14,435 pound [a,not sign16,681]. Average remuneration received equated to A 6,222 pound [a,not sign7,190] per patient. This represents a mean loss in income, compared to actual calculated costs of A 3,207 pound [a,not sign3,706] per patient. The median cost was A 9,429 pound [a,not sign10,896], increasing to A 14,435 pound [a,not sign16,681], for those requiring an upgrade from residential to nursing home care at discharge. Significant cost differences were seen comparing the actual cost to remuneration received. Interventions targeted at reducing length of stay may be cost effective.