Abstract
Hip fractures cause substantial morbidity, mortality and healthcare costs among older adults. While advances in surgical and postoperative care have improved outcomes in high-income countries, these interventions are often inaccessible in low-income and middle-income countries due to cost constraints. This study assessed the costs and outcomes of surgical versus non-surgical management of hip fractures to inform resource allocation in a resource-limited setting. Data from a prospective cohort study of patients with acute hip fractures over a 12-month postfracture follow-up period were used. Outcomes included quality-adjusted life years (QALYs), healthcare resource use and costs in 2024 US$. Differences in costs and QALYs were estimated using multivariable regression analysis, while a range of sensitivity analyses assessed the impact of different assumptions. The analysis included 137 patients with a mean age of 70 years (SD: 13.4); 60% (n=82) were female and 81.8% (n=112) had fragility fractures. Fewer than half (47%, n=64) had surgery. Surgical management incurred US$988 higher costs (95% CI US$843 to US$1132) and generated 0.122 additional QALYs (95% CI −0.034 to 0.277) compared with non-surgical care, yielding an incremental cost-effectiveness ratio (ICER) of US$8117 per QALY gained. The probability of surgery being cost-effective exceeded 50% at willingness-to-pay thresholds of US$8200 per QALY gained or higher. The results were sensitive to surgical timing: operating within 3 days of admission more than doubled health gains to 0.247 QALYs (95% CI 0.056 to 0.439) and reduced the ICER to $4974 per QALY gained compared with no surgery. In this resource-limited setting, surgical management of hip fractures is more expensive but delivers clinically meaningful benefit for patients; a gain of 0.12 QALYs per patient translating to an extra 44 days in good health. Health systems in resource-limited settings should prioritise expanding surgical access while optimising early intervention and postoperative care to maximise benefits.