Rehabilitation and care after hip fracture: a cost-utility analysis of stepped-wedge cluster randomized trial.
Jonas A Ipsen, Jan Abel Olsen, Bjarke Viberg and 3 others
PMID 39569421WHAT IT FOUND
Adding intensive physiotherapy and empowerment support to usual hip fracture care produced a tiny quality-of-life gain but cost significantly more.
It was not cost-effective overall. However, for patients discharged to their own homes, it may be viable without extra cost.
Key findings
01The intervention group had a small but statistically significant quality-of-life gain at 6 months, but no significant difference remained at 1 year.
02The intervention cost significantly more than usual care, with an incremental cost per quality-adjusted life year far exceeding common willingness-to-pay thresholds.
03Excluding patients discharged to respite care lowered incremental costs to a statistically insignificant level, suggesting potential viability for those discharged to their own homes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study excluded patients with communication impairments, dementia, or those discharged to permanent nursing homes, limiting generalizability to more complex patients. Transportation, informal care, and waiting time costs were only measured for 3 months, potentially underestimating the true cost difference. Patients discharged to respite care were unevenly distributed between groups, creating a significant cost imbalance that heavily influenced the overall results. The analysis was restricted to a healthier subgroup of patients, as those who died before follow-up were excluded.
Declared interests
The authors declared no conflicts of interest. Funding was provided by the research council at Lillebaelt Hospital, the Association of Danish Physiotherapists, and the Novo Nordic Foundation. The funders had no role in the study design, data collection, analysis, or writing.
The easy way to misread this
Do not conclude the intervention is useless for everyone. The high overall cost was driven by patients discharged to respite care. For patients discharged to their own homes, the intervention may be cost-neutral and potentially beneficial.