Hip fracture care in Zimbabwe : a cohort-based health economic analysis

Hip fractures are a leading cause of morbidity and mortality worldwide, particularly among older people. While early surgical management improves outcomes compared to non-surgical approaches, high costs of surgery pose significant barriers in low- and middle-income countries. A cost-utility analysis of hip fracture management was undertaken in Zimbabwe, to guide resource allocation and policy.

Patient-level data were obtained from a prospective cohort of adults aged 40 years and above with acute hip fractures presenting to hospital in Harare (two public; five private) between October 2021 and October 2022. Healthcare resource use and costs in 2023 USD$ were assessed from individual billing data, with imputed values used for missing resources. Health outcomes were measured in quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios (ICERs), defined as the ratio of incremental costs to incremental QALYs, were estimated using a regression approach. Sensitivity analyses assessed the impact of different assumptions on cost-effectiveness.

The cohort had 190 patients with an average age of 72 years (SD 14.3), and 51% (n = 97) were male; 61% (n = 116) had surgery for their hip fracture. Patients who underwent surgery had 0.17 (95% CI 0.10 to 0.25) additional QALYs and incurred substantially higher healthcare costs: $1,676 (95% CI 730 to 2,621) higher per patient. The ICER for the primary analysis was $9,647/QALY gained. Restricting the analysis to patients who did not experience extensive surgical delays resulted in smaller difference in costs and an ICER of $4,126/QALY gained. The results were sensitive to the exchange rate used to estimate costs.

Although patients who underwent surgery for hip fractures had higher costs, they had better health outcomes in terms of QALYs. Targeted improvements in provision of surgical care, particularly in minimizing surgical delays, could improve both patient outcomes and lower healthcare costs.