Original Article

An Economic Cost Analysis of Implementing a Frailty Care Bundle to Reduce Risk of Hospital Associated Decline Among Older Patients

Aileen Murphy¹, Federica de Blasio¹, Ann Kirby¹, Marguerite de Foubert², Corina Naughton³

1. Department of Economics, Cork University Business School, University College Cork, Ireland
2. School of Nursing and Midwifery, University College Cork, Ireland
3. School Nursing, Midwifery and Health Systems, University College Dublin, Ireland

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Keywords: Economic analysis, Fundamental care, Hip fracture, Nursing

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Abstract

Objective: To conduct an economic cost analysis and budget impact assessment (BIA) of implementing the Frailty Care Bundle (FCB) intervention nationally over five-years for hip fracture patients. The FCB was designed to reduce hospital associated decline in older hospitalised patients. Methods: The FCB was delivered in two Irish hospitals on two wards per hospital. A micro level cost analysis, from the Irish health service perspective was undertaken. Direct costs of the FCB were considered (personnel, training, resources), expressed in Euros (2020). For the BIA national population estimates for hip fracture and costs avoided were based on 18% difference in patients returning to their baseline capability in the post compared to pre-intervention group, valued using cost estimates of functional decline. Results: We estimated total intervention costs at €53,619 (89% for personnel) and the average cost per patient was €156.03. The expected costs of implementing the FCB nationally over 12-months was €57,274 per hospital (€72.92 per patient). The BIA for an expected targeted population (16,000 over 5 years), estimated that the cost of implementing the FCB (€1.2m) was less than the expected value of functional decline avoided owing to the intervention (€3.6m), suggesting a positive net effect (€2.4m). Conclusion: Investment in the FCB can be offset with more rapid patient return to baseline functional capability, reducing health care costs. Trial and Protocol Registration (retrospective): BMC ISRCTN 15145850, (https://doi.org/10.1186/ISRCTN15145850).

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