title: A cost-effectiveness analysis of the arthroplasty options for displaced femoral neck fractures in the active, healthy, elderly population.
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.
authors.affiliation: Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts, USA. P60 AR48094
authors.forename: James
authors.initials: J
authors.lastname: Slover
authors.forename: Michael V
authors.initials: MV
authors.lastname: Hoffman
authors.forename: Henrik
authors.initials: H
authors.lastname: Malchau
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Koval
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005265:Femoral Neck Fractures / Q000601:surgery*; D006801:Humans; D008390:Markov Chains; D008962:Models, Theoretical; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome