[Analysis of health insurance costs in cases of patients under 60 years old with medial femoral neck fracture treated primarily with screw fixation or hip replacement]

Abstract

Aim: The aim of the study is to analyse the cost of patients under the age of 60 with medial femoral neck fracture up to 2 years follow up after the primary treatment including cost of acute and chronic inpatient care, outpatient care, sickness pay and changes in ability to work according to the most frequently used surgical methods and Garden classification.

Patients and methods: Patients were identified from the financial database of the National Health Insurance Fund Administration and a questionnaire was used for further analysis. The costs of patients were analysed in three groups I) all patients, (II.) patients with further treatment because of complications, and (III.) patients cured by one primary treatment.

Results: Altogether 518 patients were included into the study: 413 (79.7%) with primary screw fixation and 48 (9.3%) with hip replacement. The average cost for all patients (I) for the 2 years follow up was 582.181 Hungarian Forint (HUF) with screw fixation and 545.300 HUF with hip replacement. The average cost per patients in the group with one primary surgical treatment (II) was (N = 337, 81.6%) 441.466 HUF with screw fixation and (N = 44, 91.6%) 561.027 HUF with hip replacement. The average cost per patients in the subgroup with further hospitalization because of complications (II) was (N = 76, 18.4%) 1.005.578 HUF with screw fixation and (N = 4, 8.4%) 775.640 HUF with hip replacement. The costs according to Garden classification (I-IV.) were as follows: patients without complications from 436.681 HUF to 659.160 HUF and patients with complications from 628.323 HUF to 1.192.564 HUF.

Conclusion: The results suggest that patients (N = 76, 18.4%) having displaced fractures with screw fixation receiving further treatment should be treated - knowing the vitality of femoral head - with stable osteosynthesis or hip replacement in order to reduce further reoperations and finally, health insurance expenditures and patients' burden.