title: Financial aspects of arthroplasty options for intra-capsular neck of femur fractures: a cost analysis study to review the financial impacts of implementing NICE guidelines in the NHS organisations.
abstract: OBJECTIVE
  To review the financial aspects of implementing the latest NICE guideline for neck of femur fracture (CG124), which recommends offering Total Hip Replacement (THR) as an alternative to hemiarthroplasty (HA) for patients, who are independently mobile before injury, not cognitively impaired and well enough to tolerate the operation.
  
  
  METHODS
  Between April 2011 and April 2013 data collected from our Hip Fracture database (NHFD) showed that by following the latest NICE guideline (CG124), out of 840 patients, 176 patients (21%) should be considered for THR rather than HA. Individual procedure costs were calculated by considering cost of implants and consumables (extracted from providers' published catalogues) added to the cost of running operating theatre for each operation. We then used the national tariff for each procedure using relevant HRG codes to calculate the total cost and the income to the Trust.
  
  
  RESULTS
  Our data indicated that by implementing the latest NICE guideline (CG124), 37.1% of patients with intra-capsular fracture neck of femur (IC-NOF fracture) would be eligible for THR rather than HA. Although performing cemented THR was the more expensive procedure, our calculation shows that despite increased cost of performing the operation, Trusts can increase their net income by £300-600 (depending on their market force factor) per patient using correct HRG coding and National Tariff.
  
  
  CONCLUSIONS
  Utilising 2012-13 National Tariff, performing a cemented THR instead of a HA for patients with IC-NOF fracture, as recommended by the latest NICE guideline (CG124) can increase the Trust's revenue per patient in a predictable way. This practice not only results in potentially better patient outcomes but also can increase financial reward and potential for reinvestment in all hip fracture units in the UK.
authors: Orthopaedic Department, Epsom and St Helier Hospitals NHS Trust, United Kingdom. Electronic address: saman.horriat@gmail.com.
authors: S
authors: S
authors: Horriat
authors: Orthopaedic Department, Epsom and St Helier Hospitals NHS Trust, United Kingdom.
authors: P D
authors: PD
authors: Hamilton
authors: Orthopaedic Department, Epsom and St Helier Hospitals NHS Trust, United Kingdom.
authors: A H
authors: AH
authors: Sott
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000401:mortality; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D005265:Femoral Neck Fractures / Q000191:economics* / Q000401:mortality; D017408:Guidelines as Topic; D062785:Hemiarthroplasty / Q000191:economics* / Q000401:mortality; D006801:Humans; D012189:Retrospective Studies; D013222:State Medicine / Q000191:economics; D006113:United Kingdom / Q000453:epidemiology
keywords: Cost analysis; Hip fractures; National guideline