Elsevier

The Journal of Arthroplasty

Volume 24, Issue 6, September 2009, Pages 854-860
The Journal of Arthroplasty

A Cost-Effectiveness Analysis of the Arthroplasty Options for Displaced Femoral Neck Fractures in the Active, Healthy, Elderly Population

https://doi.org/10.1016/j.arth.2008.05.008Get rights and content

Abstract

This study was performed to explore the cost-effectiveness of total hip arthroplasty (THA) compared with hemiarthroplasty (HEMI) in the treatment of displaced femoral neck fractures in active otherwise healthy older patients in whom the optimum treatment is believed to be an arthroplasty procedure. A Markov decision model was used to determine whether THA or HEMI was most cost-effective for the management of a displaced femoral neck fracture in this patient population. Total hip arthroplasty was associated with an average cost $3000 more than HEMI, and the average quality-adjusted life year gain was 1.53. The incremental cost-effectiveness ratio associated with the THA treatment strategy is $1960 per quality-adjusted life year. Currently available data support the use of THA as the more cost-effective treatment strategy in this specific population. The increased upfront cost appears to be offset by the improved functional results when compared with HEMI in this select patient group.

Section snippets

Patient Population

To model the healthy, active, elderly patient population, we evaluated a theoretical cohort of patients aged 70 years who sustained a displaced femoral neck fracture. This age was chosen to represent a typical age for patients where both a HEMI and a THA may be indicated. All patients were assumed to have fractures that would be ideally treated with an arthroplasty procedure, although in practice, the clinical criteria for this lies with individual surgeons and remains to be clearly defined.

Model Design

A

Results

The results for the base case are shown in Table 2. With the parameters discussed in the Methods section and shown in Table 2, THA was associated with an average cost of $3000 higher than HEMI, and the average utility gain was 1.53 QALYs for the 20-year period of the Markov model. This resulted in an ICER of $1960 for the THA treatment strategy, which is well below the $50 000 threshold used for determining the cost-effectiveness of treatment interventions.

The results of sensitivity analyses are

Discussion

This study focuses on a narrow subset of patients who have sustained a displaced femoral neck fracture, the active, healthy, elderly patient. The results of this analysis demonstrate several important points. First, it appears that THA is the more cost-effective arthroplasty option for displaced femoral neck fractures in the active, healthy, elderly patient population, despite the potential for increased morbidity compared with HEMI. The ICER is $1960 per QALY, which is well below the $50 000

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  • Cited by (0)

    This research was supported in part with funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (P60 AR48094).

    Benefits or funds were received in partial or total support of the research material described in this article. These benefits or support were received from the following sources: NIH National Institute for Arthritis and Musculoskeletal and Skin Disease Grant.

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