Treatment of displaced femoral neck fractures in the elderly: a cost-benefit analysis.
BACKGROUND
The optimal treatment for displaced femoral neck fractures in elderly patients is controversial. Compared with hemiarthroplasty (HA), internal fixation (IF) is associated with less operative trauma, bleeding, and possibly lower mortality at the expense of a higher reoperation rate and possibly increased cost.


METHODS
We estimated the costs from a third party payer perspective after 1 year of 2 strategies (HA and IF) for the treatment of femoral neck fractures in patients over the age of 60 years. Using a decision board, we elicited patient preferences for the 2 operative approaches and calculated the net benefit using the willingness-to-pay technique.


RESULTS
The 1-year projected cost of 1 IF was $18,100, and that of 1 HA was $15,843 (incremental cost of $2257 for each IF). Of 108 participants, 61 (56.5%) chose IF as the preferred treatment option and were willing to pay an average of $3.33 per month to have this option available if needed. In Ontario, the total incremental cost of performing IF in patients that choose it was $64,714,103, and the total societal benefit was $289,263,600, yielding a net benefit of $224,549,497.


CONCLUSIONS
The benefits of IF over HA outweigh the incremental costs from the perspective of a third-party payer. IF should be available to patients that choose it.
Alolabi
Bashar
B
Department of Surgery, University of Western Ontario, Ontario, Canada.
Bajammal
Sohail
S
Shirali
Janhavi
J
Karanicolas
Paul J
PJ
Gafni
Amiram
A
Bhandari
Mohit
M
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000401:mortality*; D002170:Canada / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005265:Femoral Neck Fractures / Q000401:mortality* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000191:economics* / Q000401:mortality* / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000191:economics*; D006622:Hip Prosthesis / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome