Osteoporosis International

, Volume 23, Issue 6, pp 1711–1719 | Cite as

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

  • G. M. Waaler Bjørnelv
  • F. Frihagen
  • J. E. Madsen
  • L. Nordsletten
  • E. Aas
Original Article



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.


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



Cost-utility analysis


Health-related quality of life


Incremental cost-effectiveness ratio


Quality-adjusted life year



Kenneth Nilsen, Wender Figved, Silje Aspaas, Eivind Kaare Osnes, Bjørn Robstad, Wendy Hornum, and Kirsti Hildur Nielsen who participated considerably in the collection of data.

Conflicts of interest

All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare that (1) none of the authors have support from any company for the submitted work; (2) FF and LN have received consulting and lecturing fees from OrtoMedic who markets the orthopedic implants used in this trial and that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) GW, EA, LN, FF, and JEM have no non-financial interests that may be relevant to the submitted work.


Funding for this work was from the Norwegian Foundation for Health and Rehabilitation through the Norwegian Osteoporosis Society, South-Eastern Norway Regional Health Authority, the Norwegian Research Council, Nycomed, Smith and Nephew, and OrtoMedic. The researchers have worked independently and have not been influenced by the funders.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • G. M. Waaler Bjørnelv
    • 1
    • 2
  • F. Frihagen
    • 3
  • J. E. Madsen
    • 3
    • 4
  • L. Nordsletten
    • 3
    • 4
  • E. Aas
    • 1
  1. 1.Department of Health Management and Health EconomicsUniversity of OsloOsloNorway
  2. 2.HEHØ—Health Economic Evaluations in the South-Eastern Regional Health Authority in NorwayUniversity of OsloOsloNorway
  3. 3.Orthopaedic DepartmentOslo University HospitalOsloNorway
  4. 4.Faculty of MedicineUniversity of OsloOsloNorway

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