TY - GEN
T1 - Cost-effective rehabilitation and care after hip fracture
AU - Ipsen, Jonas Ammundsen
PY - 2024/10/24
Y1 - 2024/10/24
N2 - The overall aim of this thesis was to contribute new evidence on post-surgical rehabilitation and care following hip fracture and identify possibilities for improved
Cost-effectiveness.Study I was a systematic review with a narrative synthesis that summarised and
described the evidence base around post-surgical rehabilitation and care courses
after hip fracture comparable to a Scandinavian healthcare system. Three cost-utility
analysis matched the in- and exclusion criteria. The three interventions were
heterogen in content and when their interventions started after the hip fracture
surgery. They used the same health care sector perspective but did not measure the
same costs or indirect costs as informal care. Hence the three analysis were too
heterogen for synthesised comparisons and firm conclusions.Study II was a prospective cohort study using the Rehabilitation for Life cohort and
explored how often, to what extent, and when patients received help from informal
caregivers following hip fracture. Of the 244 patients, 90% reported receiving
informal care. The median total amount of informal care was 32 hours; at the twelveweek follow-up, 36% still received informal care. In conclusion informal care is very
prevalent after hip fracture and should be measured as a cost. Study III was the study protocol for the Rehabilitation for Life trial, and described the
design, methods and conduct of this trial.Study IV was a cost-utility analysis with a limited societal perspective comparing the
cost per QALY between Rehabilitation for Life and usual rehabilitation and care after
hip fracture. The usual rehabilitation and care was the cost-effective approach.The findings of this thesis have provided new insights into patients' need for
rehabilitation and care and identified an approach that is slightly better but costly
compared to usual rehabilitation and care after a hip fracture. Study I established
that the evidence base on rehabilitation and care after hip fracture was limited and
heterogeneous and highlighted the need for more comprehensive measurements of
cost. Study II demonstrated the extensive role played by relatives in meeting a
patient's need for care after hip fracture, providing a strong argument for including
measurements of informal care after hip fracture. Study III provided an in-depth
description of the Rehabilitation for Life intervention. Study IV compared and ranked
the costs and effects of Rehabilitation for Life and usual rehabilitation and care after
hip fracture. Rehabilitation for Life had a small but statistically significant additional
effect on patients' quality of life, but at a higher cost.
AB - The overall aim of this thesis was to contribute new evidence on post-surgical rehabilitation and care following hip fracture and identify possibilities for improved
Cost-effectiveness.Study I was a systematic review with a narrative synthesis that summarised and
described the evidence base around post-surgical rehabilitation and care courses
after hip fracture comparable to a Scandinavian healthcare system. Three cost-utility
analysis matched the in- and exclusion criteria. The three interventions were
heterogen in content and when their interventions started after the hip fracture
surgery. They used the same health care sector perspective but did not measure the
same costs or indirect costs as informal care. Hence the three analysis were too
heterogen for synthesised comparisons and firm conclusions.Study II was a prospective cohort study using the Rehabilitation for Life cohort and
explored how often, to what extent, and when patients received help from informal
caregivers following hip fracture. Of the 244 patients, 90% reported receiving
informal care. The median total amount of informal care was 32 hours; at the twelveweek follow-up, 36% still received informal care. In conclusion informal care is very
prevalent after hip fracture and should be measured as a cost. Study III was the study protocol for the Rehabilitation for Life trial, and described the
design, methods and conduct of this trial.Study IV was a cost-utility analysis with a limited societal perspective comparing the
cost per QALY between Rehabilitation for Life and usual rehabilitation and care after
hip fracture. The usual rehabilitation and care was the cost-effective approach.The findings of this thesis have provided new insights into patients' need for
rehabilitation and care and identified an approach that is slightly better but costly
compared to usual rehabilitation and care after a hip fracture. Study I established
that the evidence base on rehabilitation and care after hip fracture was limited and
heterogeneous and highlighted the need for more comprehensive measurements of
cost. Study II demonstrated the extensive role played by relatives in meeting a
patient's need for care after hip fracture, providing a strong argument for including
measurements of informal care after hip fracture. Study III provided an in-depth
description of the Rehabilitation for Life intervention. Study IV compared and ranked
the costs and effects of Rehabilitation for Life and usual rehabilitation and care after
hip fracture. Rehabilitation for Life had a small but statistically significant additional
effect on patients' quality of life, but at a higher cost.
U2 - 10.21996/tght-nz92
DO - 10.21996/tght-nz92
M3 - Ph.D. thesis
PB - Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet
ER -