Literature DB >> 21997224

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 Bjørnelv1, F Frihagen, J E Madsen, L Nordsletten, E Aas.   

Abstract

UNLABELLED: 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.

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Year:  2011        PMID: 21997224     DOI: 10.1007/s00198-011-1772-1

Source DB:  PubMed          Journal:  Osteoporos Int        ISSN: 0937-941X            Impact factor:   4.507


  30 in total

Review 1.  Bootstrapping: estimating confidence intervals for cost-effectiveness ratios.

Authors:  M K Campbell; D J Torgerson
Journal:  QJM       Date:  1999-03

2.  Cost-benefit analysis of hip fracture treatment.

Authors:  M J Parker; J W Myles; J K Anand; R Drewett
Journal:  J Bone Joint Surg Br       Date:  1992-03

3.  The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips.

Authors:  Torsten Johansson; Margareta Bachrach-Lindström; Per Aspenberg; Dick Jonsson; Ola Wahlström
Journal:  Int Orthop       Date:  2005-12-23       Impact factor: 3.075

Review 4.  Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2,289 patients.

Authors:  Cecilia Rogmark; Olof Johnell
Journal:  Acta Orthop       Date:  2006-06       Impact factor: 3.717

5.  Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips.

Authors:  T Johansson; S A Jacobsson; I Ivarsson; A Knutsson; O Wahlström
Journal:  Acta Orthop Scand       Date:  2000-12

6.  Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients.

Authors:  J F Keating; A Grant; M Masson; N W Scott; J F Forbes
Journal:  J Bone Joint Surg Am       Date:  2006-02       Impact factor: 5.284

7.  Costs of internal fixation and arthroplasty for displaced femoral neck fractures: a randomized study of 68 patients.

Authors:  Cecilia Rogmark; Ake Carlsson; Olof Johnell; Ingemar Sembo
Journal:  Acta Orthop Scand       Date:  2003-06

8.  International variations in hip fracture probabilities: implications for risk assessment.

Authors:  John A Kanis; Olof Johnell; Chris De Laet; Bengt Jonsson; Anders Oden; Alan K Ogelsby
Journal:  J Bone Miner Res       Date:  2002-07       Impact factor: 6.741

9.  Outcome after femoral neck fractures: a comparison of Harris Hip Score, Eq-5d and Barthel Index.

Authors:  Frede Frihagen; Margreth Grotle; Jan Erik Madsen; Torgeir Bruun Wyller; Petter Mowinckel; Lars Nordsletten
Journal:  Injury       Date:  2008-07-25       Impact factor: 2.586

10.  Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial.

Authors:  Frede Frihagen; Lars Nordsletten; Jan Erik Madsen
Journal:  BMJ       Date:  2007-12-04
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  17 in total

1.  Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011.

Authors:  Markus T Hongisto; Harri Pihlajamäki; Seppo Niemi; Maria Nuotio; Pekka Kannus; Ville M Mattila
Journal:  Int Orthop       Date:  2014-04-23       Impact factor: 3.075

2.  Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old.

Authors:  S K Han; H S Song; R Kim; S H Kang
Journal:  Eur J Trauma Emerg Surg       Date:  2015-04-18       Impact factor: 3.693

3.  The Result of In Situ Pinning for Valgus Impacted Femoral Neck Fractures of Patients over 70 Years Old.

Authors:  Yoon-Chung Kim; Joo-Yup Lee; Joo-Hyoun Song; Seungbae Oh
Journal:  Hip Pelvis       Date:  2014-12-31

4.  The societal costs of femoral neck fracture patients treated with internal fixation.

Authors:  S M Zielinski; C A M Bouwmans; M J Heetveld; M Bhandari; P Patka; E M M Van Lieshout
Journal:  Osteoporos Int       Date:  2013-09-27       Impact factor: 4.507

5.  Femoral neck system versus cannulated screws for fixation of femoral neck fracture in young adults: a systematic review and meta-analysis.

Authors:  Yao Lu; Zhilong Huang; Yibo Xu; Qiang Huang; Cheng Ren; Ming Li; Zhong Li; Liang Sun; Hanzhong Xue; Kun Zhang; Qian Wang; Teng Ma
Journal:  Am J Transl Res       Date:  2022-08-15       Impact factor: 3.940

Review 6.  Surgical interventions for treating intracapsular hip fractures in older adults: a network meta-analysis.

Authors:  Sharon R Lewis; Richard Macey; Jamie Stokes; Jonathan A Cook; William Gp Eardley; Xavier L Griffin
Journal:  Cochrane Database Syst Rev       Date:  2022-02-14

7.  Efficacies of surgical treatments based on Harris hip score in elderly patients with femoral neck fracture.

Authors:  Chengwei Liang; Fengjian Yang; Weilong Lin; Yongqian Fan
Journal:  Int J Clin Exp Med       Date:  2015-05-15

8.  A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2.

Authors:  Simon C Mears; Stephen L Kates
Journal:  Geriatr Orthop Surg Rehabil       Date:  2015-06

9.  Randomized trial of hemiarthroplasty versus internal fixation for femoral neck fractures: no differences at 6 years.

Authors:  Ragnhild Øydna Støen; Cathrine M Lofthus; Lars Nordsletten; Jan Erik Madsen; Frede Frihagen
Journal:  Clin Orthop Relat Res       Date:  2013-08-24       Impact factor: 4.176

10.  Outcome of hemiarthroplasty and total hip replacement for active elderly patients with displaced femoral neck fractures: a meta-analysis of 8 randomized clinical trials.

Authors:  Yiqiong Zhao; Dong Fu; Kai Chen; Guodong Li; Zhengdong Cai; Yan Shi; Xiaobing Yin
Journal:  PLoS One       Date:  2014-05-22       Impact factor: 3.240

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