Cost-effective rehabilitation and care after hip fracture

Jonas Ammundsen Ipsen*

*Corresponding author for this work

Research output: ThesisPh.D. thesis

Abstract

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. 
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
Supervisors/Advisors
  • Bruun, Inge Hansen, Principal supervisor
  • Viberg, Bjarke, Co-supervisor
  • Draborg, Eva, Co-supervisor
Date of defence8. Nov 2024
Publisher
DOIs
Publication statusPublished - 24. Oct 2024

Note re. dissertation

A print copy of the thesis can be accessed at the library. 

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