Abstract
Background: A recent systematic review has indicated that mortality within the first year after hip fracture repair increases significantly if the time from hospital admission to surgery exceeds forty-eight hours. Further investigation has shown that avoidable, systems-based factors contribute substantially to delay in surgery. In this study, an economic evaluation was conducted to determine the cost-effectiveness of a hypothetical scenario in which resources are allocated to expedite surgery so that it is performed within forty-eight hours after admission. Methods: We created a decision tree to tabulate incremental cost and quality-adjusted life years in order to evaluate the cost-effectiveness of two potential strategies. Several factors, including personnel cost, patient volume, percentage of patients receiving surgical treatment within forty-eight hours, andmortality associated with delayed surgery, were considered. One strategy focused solely on expediting preoperative evaluation by employing personnel to conduct the necessary diagnostic tests and a hospitalist physician to conduct the medical evaluation outside of regular hours. The second strategy added an on-call team(nurse, surgical technologist, and anesthesiologist) to staff an operating roomoutside of regular hours. Results: The evaluation-focused strategy was cost-effective, with an incremental cost-effectiveness ratio of $2318 per quality-adjusted life year, and became cost-saving (a dominant therapeutic approach) if ≥93% of patients underwent expedited surgery, the hourly cost of retaining a diagnostic technologist on call was <$20.80, or <15% of the hospitalist's salary was funded by the strategy. The second strategy, which added an on-call surgical team, was also cost-effective, with an incremental cost-effectiveness ratio of $43,153 per quality-adjusted life year. Sensitivity analysis revealed that this strategy remained cost-effective if the odds ratio of one-year mortality associated with delayed surgery was >1.28, ‡88% of patients underwent early surgery, or ≥339.9 patients with a hip fracture were treated annually. Conclusions: The results of our study suggest that systems-based solutions to minimize operative delay, such as a dedicated on-call support team, can be cost-effective. Additionally, an evaluation-focused intervention can be cost-saving, depending on its success rate and associated personnel cost. Level of Evidence: Economic and decision analysis Level II. See Instructions to Authors for a complete description of levels of evidence.
| Original language | English |
|---|---|
| Pages (from-to) | 1326-1334 |
| Number of pages | 9 |
| Journal | Journal of Bone and Joint Surgery - Series A |
| Volume | 93 |
| Issue number | 14 |
| DOIs | |
| State | Published - Jul 20 2011 |
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ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine
Cite this
An economic evaluation of a systems-based strategy to expedite surgical treatment of hip fractures. / Dy, Christopher J.; McCollister, Kathryn; Lubarsky, David; Lane, Joseph M.
In: Journal of Bone and Joint Surgery - Series A, Vol. 93, No. 14, 20.07.2011, p. 1326-1334.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - An economic evaluation of a systems-based strategy to expedite surgical treatment of hip fractures
AU - Dy, Christopher J.
AU - McCollister, Kathryn
AU - Lubarsky, David
AU - Lane, Joseph M.
PY - 2011/7/20
Y1 - 2011/7/20
N2 - Background: A recent systematic review has indicated that mortality within the first year after hip fracture repair increases significantly if the time from hospital admission to surgery exceeds forty-eight hours. Further investigation has shown that avoidable, systems-based factors contribute substantially to delay in surgery. In this study, an economic evaluation was conducted to determine the cost-effectiveness of a hypothetical scenario in which resources are allocated to expedite surgery so that it is performed within forty-eight hours after admission. Methods: We created a decision tree to tabulate incremental cost and quality-adjusted life years in order to evaluate the cost-effectiveness of two potential strategies. Several factors, including personnel cost, patient volume, percentage of patients receiving surgical treatment within forty-eight hours, andmortality associated with delayed surgery, were considered. One strategy focused solely on expediting preoperative evaluation by employing personnel to conduct the necessary diagnostic tests and a hospitalist physician to conduct the medical evaluation outside of regular hours. The second strategy added an on-call team(nurse, surgical technologist, and anesthesiologist) to staff an operating roomoutside of regular hours. Results: The evaluation-focused strategy was cost-effective, with an incremental cost-effectiveness ratio of $2318 per quality-adjusted life year, and became cost-saving (a dominant therapeutic approach) if ≥93% of patients underwent expedited surgery, the hourly cost of retaining a diagnostic technologist on call was <$20.80, or <15% of the hospitalist's salary was funded by the strategy. The second strategy, which added an on-call surgical team, was also cost-effective, with an incremental cost-effectiveness ratio of $43,153 per quality-adjusted life year. Sensitivity analysis revealed that this strategy remained cost-effective if the odds ratio of one-year mortality associated with delayed surgery was >1.28, ‡88% of patients underwent early surgery, or ≥339.9 patients with a hip fracture were treated annually. Conclusions: The results of our study suggest that systems-based solutions to minimize operative delay, such as a dedicated on-call support team, can be cost-effective. Additionally, an evaluation-focused intervention can be cost-saving, depending on its success rate and associated personnel cost. Level of Evidence: Economic and decision analysis Level II. See Instructions to Authors for a complete description of levels of evidence.
AB - Background: A recent systematic review has indicated that mortality within the first year after hip fracture repair increases significantly if the time from hospital admission to surgery exceeds forty-eight hours. Further investigation has shown that avoidable, systems-based factors contribute substantially to delay in surgery. In this study, an economic evaluation was conducted to determine the cost-effectiveness of a hypothetical scenario in which resources are allocated to expedite surgery so that it is performed within forty-eight hours after admission. Methods: We created a decision tree to tabulate incremental cost and quality-adjusted life years in order to evaluate the cost-effectiveness of two potential strategies. Several factors, including personnel cost, patient volume, percentage of patients receiving surgical treatment within forty-eight hours, andmortality associated with delayed surgery, were considered. One strategy focused solely on expediting preoperative evaluation by employing personnel to conduct the necessary diagnostic tests and a hospitalist physician to conduct the medical evaluation outside of regular hours. The second strategy added an on-call team(nurse, surgical technologist, and anesthesiologist) to staff an operating roomoutside of regular hours. Results: The evaluation-focused strategy was cost-effective, with an incremental cost-effectiveness ratio of $2318 per quality-adjusted life year, and became cost-saving (a dominant therapeutic approach) if ≥93% of patients underwent expedited surgery, the hourly cost of retaining a diagnostic technologist on call was <$20.80, or <15% of the hospitalist's salary was funded by the strategy. The second strategy, which added an on-call surgical team, was also cost-effective, with an incremental cost-effectiveness ratio of $43,153 per quality-adjusted life year. Sensitivity analysis revealed that this strategy remained cost-effective if the odds ratio of one-year mortality associated with delayed surgery was >1.28, ‡88% of patients underwent early surgery, or ≥339.9 patients with a hip fracture were treated annually. Conclusions: The results of our study suggest that systems-based solutions to minimize operative delay, such as a dedicated on-call support team, can be cost-effective. Additionally, an evaluation-focused intervention can be cost-saving, depending on its success rate and associated personnel cost. Level of Evidence: Economic and decision analysis Level II. See Instructions to Authors for a complete description of levels of evidence.
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U2 - 10.2106/JBJS.I.01132
DO - 10.2106/JBJS.I.01132
M3 - Article
C2 - 21792499
AN - SCOPUS:80052853795
VL - 93
SP - 1326
EP - 1334
JO - Journal of Bone and Joint Surgery - American Volume
JF - Journal of Bone and Joint Surgery - American Volume
SN - 0021-9355
IS - 14
ER -