# Health-economic evaluation of orthogeriatric co-management for patients with pelvic or vertebral fragility fractures

## TL;DR

This study evaluates the health and economic outcomes of orthogeriatric co-management for elderly patients with pelvic or vertebral fractures in Germany.

## Contribution

The study provides a health-economic evaluation of OGCM for pelvic and vertebral fractures, an area with limited prior research.

## Key findings

- Total healthcare costs were significantly higher for patients treated in OGCM hospitals.
- The probability of cost-effectiveness did not exceed 95% for either fracture type at the evaluated willingness-to-pay thresholds.
- The study suggests that assigning patients based on hospital type may have underestimated OGCM's true effect.

## Abstract

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.

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.

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.

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.

The online version contains supplementary material available at 10.1186/s12877-024-05225-5.