title: Quality of life, resource use, and costs related to hip fracture in Estonia.
abstract: We assessed the impact of hip fracture on health-related quality of life (HRQoL) and costs in Estonia. The mean 18-month HRQoL loss in quality adjusted life years (QALY) was estimated at 0.31, and the average cumulative cost from a societal perspective was 8146 euros per hip fracture patient.
  
  
  
  The aim of this study is to estimate the impact of hip fracture on HRQoL, resource consumption, and cost over 18 months after the fracture among individuals aged over 50 in Estonia.
  
  
  
  A cohort of 205 hip fracture patients ≥50 years was followed up for 18 months. HRQoL was estimated before fracture (recall), after fracture, and at 4, 12, and 18 months using the EQ-5D instrument. Health care utilization and costs were obtained from a public health insurance fund database; social, informal, and indirect costs were estimated using patient-reported data.
  
  
  
  Hip fracture resulted in the mean 18-month HRQoL loss of 0.31 QALYs. The mean 18-months cumulative cost of hip fracture from a societal perspective was estimated at 8146 (95 % CI 6236-10717) euros per patient. Most of the cost was related to health care (56 %) and informal care (33 %), while social care contributed only 5 %. Utilization of outpatient rehabilitation and nursing care was low (8 % of patients).
  
  
  
  The impact of hip fracture on HRQoL and cost was substantial. Despite appropriate inpatient care, utilization of rehabilitation, nursing care, and social care were low and potentially insufficient to meet the needs of patients with low HRQoL. The shortfall may partially explain a remarkably high use of informal care.
authors.affiliation: Department of Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia. mikkjurisson@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Jürisson
authors.affiliation: Department of Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
authors.forename: H
authors.initials: H
authors.lastname: Pisarev
authors.affiliation: Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
authors.forename: J
authors.initials: J
authors.lastname: Kanis
authors.affiliation: Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Borgström
authors.affiliation: Mapigroup, Klarabergsviadukten 90, Hus D, 111 64, Stockholm, Sweden.|Unit of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset, 171 76, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Svedbom
authors.affiliation: Department of Internal Medicine, University of Tartu and Tartu University Hospital, L. Puusepa st 8, 51014, Tartu, Estonia.
authors.forename: R
authors.initials: R
authors.lastname: Kallikorm
authors.affiliation: Department of Internal Medicine, University of Tartu and Tartu University Hospital, L. Puusepa st 8, 51014, Tartu, Estonia.
authors.forename: M
authors.initials: M
authors.lastname: Lember
authors.affiliation: Department of Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
authors.forename: A
authors.initials: A
authors.lastname: Uusküla
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D004957:Estonia; D005260:Female; D017048:Health Care Costs; D006295:Health Resources; D006620:Hip Fractures / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
keywords: Cost of illness; Disease burden; Estonia; Health-related quality of life; Hip fracture; Osteoporosis; Resource use