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Costs after hip fracture in independently living patients: a randomised comparison of three rehabilitation modalities [with consumer summary]
Lahtinen A, Leppilahti J, Vahanikkila H, Harmainen S, Koistinen P, Rissanen P, Jalovaara P
Clinical Rehabilitation 2017 May;31(5):672-685
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate costs and cost-effectiveness of physical and geriatric rehabilitation after hip fracture. DESIGN: 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). MAIN MEASURES: 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 (Euro 4,945.2) was significantly less expensive than physical (Euro 6,609.0, p = 0.002) and geriatric rehabilitation (Euro 7,034.7 p < 0.001). Total institutional care costs (primary treatment, rehabilitation, and post-rehabilitation hospital care) were lower for control (Euro 13,438.4) than geriatric rehabilitation (Euro 17,201.7, p < 0.001), but did not differ between control and physical rehabilitation (Euro 15,659.1, 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 (Euro 36,356, Euro 51,018) than control rehabilitation (Euro 38,018, Euro 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.

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