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.
Faculty of Economics and Business Administration, University of Iceland, Gimli v/Saemundargotu, 101 Reykjavik, Iceland. eyjolfurs@gmail.com
Eyjolfur
E
Sigurdsson
Kristin
K
Siggeirsdottir
Halldor
H
Jonsson
Vilmundur
V
Gudnason
Thorolfur
T
Matthiasson
Brynjolfur Y
BY
Jonsson
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