title: Costs after hip fracture in independently living patients: a randomised comparison of three rehabilitation modalities.
abstract: OBJECTIVE
  To evaluate costs and cost-effectiveness of physical and geriatric rehabilitation after hip fracture.
  
  
  METHODS
  Prospective randomised study (mean age 78 years, 105 male, 433 female) in different rehabilitation settings: physically oriented (187 patients), geriatrically oriented (171 patients), and healthcare centre hospital (control, 180 patients).
  
  
  METHODS
  At 12 months post-fracture, we collected data regarding days in rehabilitation, post-rehabilitation hospital treatment, other healthcare service use, number of re-operations, taxi use by patient or relative, and help from relatives.
  
  
  RESULTS
  Control rehabilitation (4945,2€) was significantly less expensive than physical (6609.0€, p=0.002) and geriatric rehabilitation (7034.7€ p<0.001). Total institutional care costs (primary treatment, rehabilitation, and post-rehabilitation hospital care) were lower for control (13,438.4€) than geriatric rehabilitation (17,201.7€, p<0.001), but did not differ between control and physical rehabilitation (15659.1€, p=0.055) or between physical and geriatric rehabilitation ( p=0.252). Costs of help from relatives (estimated as 30%, 50% and 100% of a home aid's salary) with physical rehabilitation were lower than control ( p=0.016) but higher than geriatric rehabilitation ( p=0.041). Total hip fracture treatment costs were lower with physical (36,356€, 51,018€) than control rehabilitation (38,018€, 57,031€) at 50% and 100% of salary ( p=0.032, p=0.014, respectively). At one year post-fracture, 15D-score was significantly higher in physical rehabilitation group (0.697) than geriatric rehabilitation group (0.586, p=0.008) and control group (0.594, p=0.009).
  
  
  CONCLUSIONS
  Considering total costs one year after hip fracture the treatment including physical rehabilitation is significantly more cost-effective than routine treatment. This effect could not be seen between routine treatment and treatment including geriatric rehabilitation.
authors.affiliation: 1 Department of Orthopedic, Oulu University Hospital, Oulu, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Lahtinen
authors.affiliation: 1 Department of Orthopedic, Oulu University Hospital, Oulu, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Leppilahti
authors.affiliation: 2 Department of Trauma Surgery and Dentistry, Oulu University Hospital, Oulu, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Vähänikkilä
authors.affiliation: 1 Department of Orthopedic, Oulu University Hospital, Oulu, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Harmainen
authors.affiliation: 3 Health Center Hospital of Oulu, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Koistinen
authors.affiliation: 4 School of Public Health Univ. of Tampere, Tampere, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Rissanen
authors.affiliation: 1 Department of Orthopedic, Oulu University Hospital, Oulu, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Jalovaara
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000191:economics* / Q000534:rehabilitation; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics* / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000191:economics*; D011446:Prospective Studies; D012046:Rehabilitation / Q000191:economics* / Q000379:methods; D012047:Rehabilitation Centers / Q000191:economics; D018709:Statistics, Nonparametric
keywords: Hospital costs; community costs; cost of rehabilitation; cost-effect; hip fracture; independent living