Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial
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We estimated the cost-effectiveness of hemiarthroplasty compared to internal fixation for elderly patients with displaced femoral neck fractures. Over 2 years, patients treated with hemiarthroplasty gained more quality-adjusted life years than patients treated with internal fixation. In addition, costs for hemiarthroplasty were lower. Hemiarthroplasty was thus cost effective.
Estimating the cost utility of hemiarthroplasty compared to internal fixation in the treatment of displaced femoral neck fractures in the elderly.
A cost-utility analysis (CUA) was conducted alongside a clinical randomized controlled trial at a university hospital in Norway; 166 patients, 124 (75%) women with a mean age of 82 years were randomized to either internal fixation (n = 86) or hemiarthroplasty (n = 80). Patients were followed up at 4, 12, and 24 months. Health-related quality of life was assessed with the EQ-5D, and in combination with time used to calculate patients’ quality-adjusted life years (QALYs). Resource use was identified, quantified, and valued for direct and indirect hospital costs and for societal costs. Results were expressed in incremental cost-effectiveness ratios.
Over the 2-year period, patients treated with hemiarthroplasty gained 0.15–0.20 more QALYs than patients treated with internal fixation. For the hemiarthroplasty group, the direct hospital costs, total hospital costs, and total costs were non-significantly less costly compared with the internal fixation group, with an incremental cost of €2,731 (p = 0.81), €2,474 (p = 0.80), and €14,160 (p = 0.07), respectively. Thus, hemiarthroplasty was the dominant treatment. Sensitivity analyses by bootstrapping supported these findings.
Hemiarthroplasty was a cost-effective treatment. Trial registration, NCT00464230.
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- Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial
Volume 23, Issue 6 , pp 1711-1719
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Cost-effectiveness analysis
- Femoral neck fractures
- Internal fixation
- Sensitivity analysis
- Surgical treatment
- Industry Sectors
- Author Affiliations
- 1. Department of Health Management and Health Economics, University of Oslo, 1089, Blindern, 0317, Oslo, Norway
- 2. HEHØ—Health Economic Evaluations in the South-Eastern Regional Health Authority in Norway, University of Oslo, 0317, Oslo, Norway
- 3. Orthopaedic Department, Oslo University Hospital, Kirkeveien 166, 0407, Oslo, Norway
- 4. Faculty of Medicine, University of Oslo, 0316, Oslo, Norway