The cost-effectiveness of the Scottish Hip Fracture Audit

Key findings

1. Compliance with the Scottish Hip Fracture Audit (SHFA) standards is significantly associated with improved patient survival following a hip fracture, after taking into account other factors such as age, gender, year of audit, hospital site and readmissions.
   • For every 1% increase in the proportion of SHFA standards being met, our model predicts the odds of survival at 30 days were increased by 7.2% (95%CI: 6.9% to 7.5%).
   • Given the proportion of patients who survive a hip fracture in Scotland is already over 90%, an individual patient’s probability of survival is unlikely to be notably affected by further improvements in compliance.
2. Compliance with SHFA standards is significantly associated with reduced length of stay and associated costs, taking into account age, gender, year of audit, COVID-19 and hospital site into consideration.
   • For every 1% increase in the proportion of SHFA standards being met, the length of stay costs associated with a hip fracture are reduced by 0.7%, equating to a saving of approximately £643 per patient.
3. The cost of running the audit since 2016 (i.e. 6 year costs) is between £3,048,000 and £4,686,000, depending on additional local co-ordinator costs. The modelled saving over 6 years is £30,989,395, resulting in a return on investment between £6.61 and £10.17 for every £1 invested.
4. These returns are not constant over time. It can become harder to achieve additional gains in survival after the standards have already enabled NHS Boards to change the way they provide care in order to meet the standards routinely. The impact of COVID-19 pandemic (particularly on length of stay data) also remains unclear at this stage.
5. It was not possible using the available data to explain the relative contribution of each of the standards on the outcomes of interest.

What were we asked to look at? 

We were asked to explore the cost-effectiveness of the Scottish Hip Fracture Audit (SHFA).   

Why is this important?

The SHFA is designed to drive optimal delivery of care against 12 Scottish standards. Attainment of these standards is thought to be associated with positive outcomes for patients with hip fracture, including reduced length of stay and also reduced mortality.

The SHFA was established in 1993 and ran continuously to 2008. No audits were undertaken between 2008 and 2012, after which it recommenced, and from 2016, it has developed into a continuous audit. Each year, the care of approximately 7,000 patients with hip fracture is covered by the audit. The estimated cost of a hip fracture in Scotland is not publicly available.

Referred by

The Scottish Hip Fracture Audit Quality Improvement & Research Sub-Group Committee