Economic Value and Caregiver Burden of Continuous Fascia iliaca Compartment Block in Elderly Patients with Intertrochanteric or Subtrochanteric Fracture: A Cost-Consequence Analysis Based on a Propensity Score-Matched Cohort.

BACKGROUND

Hip fracture imposes substantial clinical and economic burden on older adults in China. Continuous fascia iliaca compartment block (CFICB) may improve perioperative recovery in elderly patients with intertrochanteric or subtrochanteric fracture, but its economic consequences remain uncertain. We compared direct medical costs, caregiver-related indirect costs, and clinical outcomes of CFICB with routine systemic analgesia (RA; a non-block regimen, distinct from regional anaesthesia, of which CFICB is itself a technique).

METHODS

We performed a cost-consequence analysis alongside a propensity score-matched retrospective cohort study at Beijing Friendship Hospital. Patients aged ≥65 years treated January 2020-December 2023 were included after 1:1 matching (CFICB n = 40; RA n = 40). Healthcare-system and societal perspectives were adopted over a pre-specified one-month postoperative horizon. Direct costs came from itemised billing; caregiver time costs were valued by the replacement-cost approach and productivity losses by the human capital approach. Mean cost differences and 95% CIs used bias-corrected and accelerated bootstrap resampling.

RESULTS

Total hospitalisation costs did not differ significantly between groups (CFICB ¥51,346 ± 10,924 vs RA ¥52,481 ± 12,267; difference -¥1,135; 95% CI -¥6,287 to +¥4,017; P = 0.523). CFICB was associated with lower scheduled-analgesic (-¥177), opioid-rescue (-¥142), cognitive-change-management (-¥2,473), rehabilitation (-¥631), and ward-overhead costs from a 2.4-day shorter stay (-¥1,440; 12.3 vs 14.7 days; P = 0.001). Informal caregiver time costs (-¥3,249) and productivity losses (-¥2,536) were lower with CFICB, yielding caregiver-related indirect savings of ¥5,785 per patient; this reflects caregiverborne costs only, not total societal cost.

CONCLUSION

In this single-centre matched cohort, total hospitalisation cost did not differ significantly between groups (difference -¥1,135; P = 0.523), while pre-specified downstream and caregiver-related costs were lower with CFICB. Given the small, single-centre, retrospective design, these hypothesisgenerating findings warrant cautious interpretation and support prospective, multicentre evaluation of CFICB in elderly proximal femoral fracture patients.