What were we asked to look at?

The Scottish Health Technologies Group (SHTG) was asked to evaluate the cost-effectiveness of compliance with the standards included in the Scottish Hip Fracture Audit.

Why is this important

The hip fracture population is a complex, mostly frail group of patients, with historically high morbidity and mortality. Approximately 7000 patients fall and break their hip in Scotland every year¹. Current estimates predict that this number will increase significantly over the next 10 years associated with an increasingly frail, co-morbid and aging population ². The cost of hip fracture care is already significant at approximately £2 Billion across the U.K. per year ³, and with anticipated rises in hip fracture incidence it is likely that these costs will escalate further.

One method of providing high quality care is through provision and assessment of national standards, such as the Scottish Standards of Hip Fracture Care, with care governed by the Scottish Hip Fracture Audit (SHFA). Attainment of these standards has previously been associated with positive outcomes for hip fracture patients, such as reduced mortality, reduced length of stay, and a higher likelihood of discharge to place of domicile ⁴. Similar findings have been demonstrated within the National Hip Fracture Database (NHFD) of England ⁵.

Despite evidence for improved clinical outcomes associated with increased compliance with these audit programmes, their cost-effectiveness has never been established. Given current financial constraints affecting health and social care in Scotland, and the predicted increases in future incidence of hip fracture, a better understanding of the value of the audit is of vital importance to ongoing preservation and function of the Scottish Hip Fracture Audit.

Referred by

Chair of Scottish Hip Fracture Audit Quality Improvement & Research Sub-Group, on behalf of the Scottish Hip Fracture Audit Quality Improvement & Research Sub-Group Committee

1 Public Health Scotland. Scottish Hip Fracture Audit Annual Report 2021 2021.
2 Holt G, Smith R, Duncan K, et al. Changes in population demographics and the future incidence of hip fracture. Injury 2009;40:722-6 doi:10.1016/j.injury.2008.11.004.
3 Burge RT, Worley D, Johansen A, et al. The cost of osteoporotic fractures in the UK: projections for 2000-2020. Journal of medical economics 2001;4:51-62 doi:10.3111/200104051062.
4 Farrow L, Hall A, Wood AD, et al. Quality of Care in Hip Fracture Patients: The Relationship Between Adherence to National Standards and Improved Outcomes. J Bone Joint Surg Am 2018;100:751-7 doi:10.2106/JBJS.17.00884 [doi].
5 Oakley B, Nightingale J, Moran CG, et al. Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study. BMJ Open 2017;7:e014190-014190 doi:10.1136/bmjopen-2016-014190 [doi].