Early discharge and home intervention reduces unit costs after total hip replacement: results of a cost analysis in a randomized study.
Total hip replacement (THR) is a common and costly procedure. The number of THR is expected to increase over the coming years. Two pathways of postoperative treatment were compared in a randomized study. Fifty patients from two hospitals were randomized into a study group (SG) of 27 patients receiving preoperative and postoperative education programs, as well as home visits from an outpatient team. A control group (CG) of 23 patients received "conventional" rehabilitation augmented by a stay at a rehabilitation center if needed. All costs for the two groups both in hospitals and after discharge were collected and analyzed. On average total costs for the SG were $8,550 and $11,952 for the CG, a 28% cost reduction. Total inpatient costs were $5,225 for the SG and $6,515 for the CG. In a regression analysis the group difference is statistically significant. Adjusting for changes in the Oxford Hip Score gives effective costs (C/E). The ratio of the SGs C/E to the CGs is 0.60. That is a cost-effectiveness gain of 40%. A shorter hospital stay augmented with better preoperative education and home treatment appears to be more effective and costs less than the traditional in hospital pathway of treatment.
Sigurdsson
Eyjolfur
E
Faculty of Economics and Business Administration, University of Iceland, Gimli v/Saemundargotu, 101 Reykjavik, Iceland. eyjolfurs@gmail.com
Siggeirsdottir
Kristin
K
Jonsson
Halldor
H
Gudnason
Vilmundur
V
Matthiasson
Thorolfur
T
Jonsson
Brynjolfur Y
BY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000534:rehabilitation; D003362:Cost-Benefit Analysis; D005260:Female; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007055:Iceland; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics*; D026741:Physical Therapy Modalities