Osteoporosis International

, Volume 23, Issue 6, pp 1711–1719

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

Authors

    • Department of Health Management and Health EconomicsUniversity of Oslo
    • HEHØ—Health Economic Evaluations in the South-Eastern Regional Health Authority in NorwayUniversity of Oslo
  • F. Frihagen
    • Orthopaedic DepartmentOslo University Hospital
  • J. E. Madsen
    • Orthopaedic DepartmentOslo University Hospital
    • Faculty of MedicineUniversity of Oslo
  • L. Nordsletten
    • Orthopaedic DepartmentOslo University Hospital
    • Faculty of MedicineUniversity of Oslo
  • E. Aas
    • Department of Health Management and Health EconomicsUniversity of Oslo
Original Article

DOI: 10.1007/s00198-011-1772-1

Cite this article as:
Waaler Bjørnelv, G.M., Frihagen, F., Madsen, J.E. et al. Osteoporos Int (2012) 23: 1711. doi:10.1007/s00198-011-1772-1

Abstract

Summary

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.

Introduction

Estimating the cost utility of hemiarthroplasty compared to internal fixation in the treatment of displaced femoral neck fractures in the elderly.

Methods

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.

Results

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.

Conclusion

Hemiarthroplasty was a cost-effective treatment. Trial registration, NCT00464230.

Keywords

Cost-effectiveness analysis EQ-5D Femoral neck fractures Hemiarthroplasty Internal fixation Sensitivity analysis Surgical treatment

Abbreviations

CUA

Cost-utility analysis

HRQoL

Health-related quality of life

ICER

Incremental cost-effectiveness ratio

QALY

Quality-adjusted life year

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011