The objective of a new study published in Injury was to evaluate the cost-effectiveness of internal fixation compared with hemiarthroplasty (HA) for elderly patients with displaced femoral neck fractures.

This study included 121 patients ≥ 65 years of age who were divided into internal fixation (n = 58) or HA group (n = 63). Clinical outcome was evaluated by the EuroQol 5 dimensions (EQ-5D) score at 3, 12, and 24 months. The total costs including medical and non-medical expense were collected through hospitalization information, cost diaries and telephone interviews. A cost-utility analysis of the total costs in combination with quality-adjusted life years (QALYs) calculated by EQ-5D and survival time was conducted. Results were expressed in incremental cost-effectiveness ratio (ICER).

The results showed that:

• The mean EQ-5D index score in the HA group were higher at the early follow-up.
• At 24 months there were no differences in EQ-5D between the two treatment groups.
• Over the two-year period, patients treated with HA gained 0.09-0.10 more QALYs than those treated with internal fixation.
• The mean total costs for internal fixation (CNY 55,676) were significantly lower than for HA (CNY 80,297).
• Additionally, ICER estimated that internal fixation may be more cost-effective than HA.

From the findings, it was inferred that HA is associated with better outcome than internal fixation in the treatment of displaced femoral neck fractures in elderly patients. However, internal fixation may be more cost-effective because of the lower total cost.

Source: Injury. 2020 Mar 2. pii: S0020-1383(20)30225-4. doi: 10.1016/j.injury.2020.03.002.