Cost-effectiveness of teaching hospitals for the operative management of hip fractures.

Hospitals with lower costs are not necessarily superior to those that are more expensive, because the more costly institutions might offer better outcomes. The purpose of this study was to consider prices and outcomes in an integrated model and thereby determine if teaching hospitals are cost-effective for the care of hip fractures. We analyzed the claims data of a sample of 18,908 Medicare patients who were admitted to one of 190 acute care hospitals for surgical treatment of a hip fracture. For each hospital, we assessed the relationship between the total per capita Medicare payments over a 6-month period following admission and the 30-day and 6-month mortality. The data were analyzed as a function of hospital type: teaching vs nonteaching. The mean adjusted costs were $5910 per patient higher at teaching hospitals compared to nonteaching hospitals (approximately $24,000 vs $18,000) However, the adjusted 6-month mortality was 1.4% lower at major teaching hospitals. The adjusted incremental cost-effectiveness for teaching hospitals was $422,143 per life saved. By that measure, each life saved would have to yield nearly 8.5 additional quality-adjusted life years (QALY) to attain the $50,000/QALY standard thought to represent cost-effective spending, an unlikely target given the age of the typical hip fracture patient. Nonetheless, because teaching hospitals are more expensive than non-teaching hospitals, a relatively small cut in the overall cost of care at teaching hospitals could dramatically decrease the marginal cost of each life saved. The elements of teaching hospital care that improve survival might be identified in further studies and instituted, perhaps, at non-teaching hospitals without greatly increasing their cost structure.