Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital

Gillian H Anderson, Paul J Jenkins, David McDonald, Robert van Der Meer, Alec Morton, Margaret Nugent, Lech Rymaszewski

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)
67 Downloads (Pure)


Objective Healthcare faces the continual challenge of improving outcome while aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway.
Design Discrete event simulation was used to model and analyse cost and resource utilisation with an activity-based costing approach. Data for a full comparison before the process change was unavailable so we used a modelling approach, comparing a virtual fracture clinic (VFC) with a simulated traditional fracture clinic (TFC).
Setting The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study.
Outcome measures Our study focused exclusively on patients with non-operative trauma attending emergency department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries are presented in association with activity costs from the models.
Results Patients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face (f2f) attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p=0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI 21.74 to 23.92) per patient compared with £36.81 (95% CI 35.65 to 37.97) for the TFC pathway.
Conclusions Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional f2f clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings.
Original languageEnglish
Article number7
Pages (from-to)e014509
Number of pages12
JournalBMJ Open
Issue number9
Publication statusPublished - 7 Sep 2017


  • costs
  • fracture clinic
  • orthopaedics
  • outpatients
  • patient outcomes
  • costs and cost analysis
  • standard of care
  • humans
  • emergency service, hospital/standards
  • United Kingdom
  • critical pathways
  • hospitals
  • computer simulation
  • fractures, bone/economics
  • retrospective studies

ASJC Scopus subject areas

  • Economics, Econometrics and Finance(all)
  • Health Professions(all)
  • Medicine(all)


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