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
- 906 Downloads
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.
KeywordsCost-effectiveness analysis EQ-5D Femoral neck fractures Hemiarthroplasty Internal fixation Sensitivity analysis Surgical treatment
Health-related quality of life
Incremental cost-effectiveness ratio
Quality-adjusted life year
- 9.Parker MJ, Gurusamy K (2006) Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev 18:CD001708Google Scholar
- 22.EuroQol-group (2009) EQ-5D—a standardised instrument for use as a measure of health outcome. [Online]. Available from: www.euroqol.org. Accessed 11 March 2009
- 25.Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL (2005) Methods for the economic evaluation of health care programmes. Oxford University Press, New YorkGoogle Scholar
- 26.National Institute of Health and Clinical Excellence (2008) Guide to the methods of technology appraisal. Available from: http://www.nice.org.uk
- 27.Ministry of finance (2010) Veileder isamfunnsøkonomiske analyser (Guidelines in socioeconomic analyses). [Online]. Available from: Oslo: www.regjeringen.no/opload/FIN/Vedlegg/okstyring/Veileder_i_samfunnsokonomiske_analyser.pdf. Accessed June 2010
- 32.Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2010;16:CD001706.Google Scholar
- 33.Johansson T, Jacobsson SA, Ivarsson I, Knutsson A, Wahlström O. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips. Acta Orthop Scand. 2000;71:597–602.Google Scholar