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Abstract：
BACKGROUND: Orthogeriatric co-management (OGCM) addresses the special needs of geriatric fracture patients. Most of the research on OGCM focused on hip fractures while results concerning other severe fractures are rare. We conducted a health-economic evaluation of OGCM for pelvic and vertebral fractures.
METHODS: In this retrospective cohort study, we used German health and long-term care insurance claims data and included cases of geriatric patients aged 80 years or older treated in an OGCM (OGCM group) or a non-OGCM hospital (non-OGCM group) due to pelvic or vertebral fractures in 2014-2018. We analyzed life years gained, fracture-free life years gained, healthcare costs, and cost-effectiveness within 1 year. We applied entropy balancing, weighted gamma and two-part models. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.
RESULTS: We included 21,036 cases with pelvic (71.2% in the OGCM, 28.8% in the non-OGCM group) and 33,827 with vertebral fractures (72.8% OGCM, 27.2% non-OGCM group). 4.5-5.9% of the pelvic and 31.8-33.8% of the vertebral fracture cases were treated surgically. Total healthcare costs were significantly higher after treatment in OGCM compared to non-OGCM hospitals for both fracture cohorts. For both fracture cohorts, a 95% probability of cost-effectiveness was not exceeded for a willingness-to-pay of up to €150,000 per life year or €150,000 per fracture-free life year gained.
CONCLUSIONS: We did not obtain distinct benefits of treatment in an OGCM hospital. Assigning cases to OGCM or non-OGCM group on hospital level might have underestimated the effect of OGCM as not all patients in the OGCM group have received OGCM.
METHODS: In this retrospective cohort study, we used German health and long-term care insurance claims data and included cases of geriatric patients aged 80 years or older treated in an OGCM (OGCM group) or a non-OGCM hospital (non-OGCM group) due to pelvic or vertebral fractures in 2014-2018. We analyzed life years gained, fracture-free life years gained, healthcare costs, and cost-effectiveness within 1 year. We applied entropy balancing, weighted gamma and two-part models. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.
RESULTS: We included 21,036 cases with pelvic (71.2% in the OGCM, 28.8% in the non-OGCM group) and 33,827 with vertebral fractures (72.8% OGCM, 27.2% non-OGCM group). 4.5-5.9% of the pelvic and 31.8-33.8% of the vertebral fracture cases were treated surgically. Total healthcare costs were significantly higher after treatment in OGCM compared to non-OGCM hospitals for both fracture cohorts. For both fracture cohorts, a 95% probability of cost-effectiveness was not exceeded for a willingness-to-pay of up to €150,000 per life year or €150,000 per fracture-free life year gained.
CONCLUSIONS: We did not obtain distinct benefits of treatment in an OGCM hospital. Assigning cases to OGCM or non-OGCM group on hospital level might have underestimated the effect of OGCM as not all patients in the OGCM group have received OGCM.
摘要：
背景：骨科联合管理（OGCM）解决了老年骨折患者的特殊需求。大多数关于OGCM的研究集中在髋部骨折，而关于其他严重骨折的结果很少。我们进行了OGCM对骨盆和椎骨骨折的健康经济学评估。
方法：在这项回顾性队列研究中，我们使用德国健康和长期护理保险索赔数据,纳入2014-2018年因骨盆或椎骨骨折在OGCM(OGCM组)或非OGCM医院(非OGCM组)接受治疗的80岁或以上老年患者病例.我们分析了获得的生命岁月，获得无骨折寿命年，医疗费用,和1年内的成本效益。我们应用了熵平衡，加权伽马和两部分模型。我们计算了增量成本效益比和成本效益可接受性曲线。
结果：我们包括21,036例骨盆患者（OGCM中的71.2％，非OGCM组28.8%)和33,827例椎体骨折(72.8%OGCM,27.2%非OGCM组)。手术治疗了4.5-5.9％的骨盆骨折和31.8-33.8％的椎骨骨折病例。对于两个骨折队列，OGCM治疗后的总医疗费用均明显高于非OGCM医院。对于这两个骨折队列，对于每个生命年高达150,000欧元或每个无骨折生命年高达150,000欧元的支付意愿,成本效益的可能性未超过95%.
结论：我们在OGCM医院没有获得明显的治疗益处。将病例分配给医院级别的OGCM或非OGCM组可能低估了OGCM的效果，因为并非OGCM组中的所有患者都接受了OGCM。
方法：在这项回顾性队列研究中，我们使用德国健康和长期护理保险索赔数据,纳入2014-2018年因骨盆或椎骨骨折在OGCM(OGCM组)或非OGCM医院(非OGCM组)接受治疗的80岁或以上老年患者病例.我们分析了获得的生命岁月，获得无骨折寿命年，医疗费用,和1年内的成本效益。我们应用了熵平衡，加权伽马和两部分模型。我们计算了增量成本效益比和成本效益可接受性曲线。
结果：我们包括21,036例骨盆患者（OGCM中的71.2％，非OGCM组28.8%)和33,827例椎体骨折(72.8%OGCM,27.2%非OGCM组)。手术治疗了4.5-5.9％的骨盆骨折和31.8-33.8％的椎骨骨折病例。对于两个骨折队列，OGCM治疗后的总医疗费用均明显高于非OGCM医院。对于这两个骨折队列，对于每个生命年高达150,000欧元或每个无骨折生命年高达150,000欧元的支付意愿,成本效益的可能性未超过95%.
结论：我们在OGCM医院没有获得明显的治疗益处。将病例分配给医院级别的OGCM或非OGCM组可能低估了OGCM的效果，因为并非OGCM组中的所有患者都接受了OGCM。
