Cost-effectiveness of referrals to high-volume hospitals: An analysis based on a probabilistic Markov model for hip fracture surgeries

Previous studies suggest that German hospitals that perform a high volume of hip fracture surgeries have a lower mortality rate and shorter length of stay than low-volume hospitals. The goal of this paper was to determine the long-term cost-effectiveness (over 20 years) of referring hip fracture surgeries to high-volume hospitals, based on data from previous studies. From a societal perspective, the cost-effectiveness ratio was €15,530 per QALY (quality-adjusted life year) (95% confidence interval €9,864–€33,048), while total annual costs to the statutory health insurance amounted up to €19.6 million. The referral of hip fracture surgeries to high-volume hospitals is thus likely to be cost-effective in Germany.