title: Service use and costs of incident femoral fractures in nursing home residents in Germany: the Bavarian Fall and Fracture Prevention Project (BF2P2).
abstract: OBJECTIVE
  Hip fractures are one of the most costly consequences of falls in the elderly. Despite their increased risk of falls and fractures, nursing home residents are often neglected in service utilization and costing studies. The purpose of this study was to determine service use, initial and long-term direct costs of incident femoral fractures in nursing home residents 65 years or older in Germany.
  
  
  METHODS
  An incidence-based, bottom-up cost-of-illness study aiming at measuring fracture-related direct costs from a payer perspective was conducted.
  
  
  METHODS
  Nursing homes
  
  
  METHODS
  The retrospective dataset included all insurants of a sickness fund (Allgemeine Ortskrankenkasse Bavaria), who were 65 years or older, resided in a nursing home, and had a level of care of at least one in the statutory long-term care insurance (n = 60,091).
  
  
  METHODS
  Incident femoral fractures (ICD-10, S72) in 2006 were followed until the end of 2008, incorporating service use and costs of inpatient care (up to 12 months after the initial hospitalization episode), nursing home care (until death or the end of 2008), and ambulatory care (pharmaceuticals, nonphysician providers, and medical supply within 3 months after the initial hospitalization episode). Additional costs for nursing home and ambulatory care were determined with a before/after design. Costs beyond the year 2006 were discounted with a rate of 5%. Sensitivity analyses on key parameters were performed.
  
  
  RESULTS
  Overall mean direct costs of 9488 USD (SD ± 4453 USD, 2006) occurred for incident femoral fractures (n = 1525). This included inpatient care (90.2%), additional costs for nursing home care (7.1%), and ambulatory care (2.7%). Eighty-seven percent of the costs occurred for the initial hospitalization episode and 13% for long-term costs. After the index admission, 12.1% were admitted to a rehabilitation facility, 4.1% were rehospitalized within a year, and in 17.7% the level of care increased within 90 days after the end of the initial hospital episode. The share of residents with incident femoral fractures rehospitalized was significantly higher and costs for nonphysician providers were significantly lower for male residents.
  
  
  CONCLUSIONS
  Residents with femoral fractures used a wide range of health services. Our study underestimates the true costs to society in Germany. Efforts should be directed to economic evaluations of fall-prevention programs aiming at reducing fall-related fractures including femoral fractures.
authors: University Medical Center Hamburg-Eppendorf, Department of Medical Sociology and Health Economics, Hamburg, Germany. s.heinrich@uke.uni-hamburg.de
authors: Sven
authors: S
authors: Heinrich
authors: Kilian
authors: K
authors: Rapp
authors: Ulrich
authors: U
authors: Rissmann
authors: Clemens
authors: C
authors: Becker
authors: Hans-Helmut
authors: HH
authors: König
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003365:Costs and Cost Analysis / Q000379:methods; D016208:Databases, Factual; D005260:Female; D005269:Femur / Q000293:injuries*; D050723:Fractures, Bone / Q000191:economics* / Q000453:epidemiology*; D005858:Germany / Q000453:epidemiology; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009735:Nursing Homes; D012189:Retrospective Studies