The cost of hemiarthroplasty compared to that of internal fixation for femoral neck fractures. 2-year results involving 222 patients based on a randomized controlled trial.
OBJECTIVE
There is very little information on the cost of different treatments for femoral neck fractures. We assessed whether total hospital and societal costs of treatment of elderly patients with displaced femoral neck fractures differ between patients operated with internal fixation or hemiarthroplasty.


METHODS
222 patients (mean age 83 years, 165 women (74%)) who had been randomized to internal fixation or hemiarthroplasty were followed for 2 years. Resource use in hospital, rehabilitation, community-based care, and nursing home use were identified, quantified, evaluated, and analyzed.


RESULTS
The average cost per patient for the initial hospital stay was lower for patients in the internal fixation group than in the hemiarthroplasty group (9,044 euro vs. 11,887 euro, p < 0.01). When all hospital costs, i.e. rehabilitation, reoperations, and formal and informal contact with the hospital were included, the costs were similar (21,709 euro for internal fixation vs. 19,976 euro for hemiarthroplasty). When all costs were included (hospital admissions, cost of nursing home, and community-based care), internal fixation was the most expensive treatment (47,186 euro vs. 38,615 euro (p = 0.09)).


CONCLUSIONS
The initial lower average cost per patient for internal fixation as treatment for a femoral neck fracture cannot be used as an argument in favor of this treatment, since the average cost per patient is more than outweighed by subsequent costs, mainly due to a higher reoperation rate after internal fixation.
Frihagen
Frede
F
Department of Orthopedics, Oslo University Hospital, Norway. j.f.frihagen@medisin.uio.no
Waaler
Gudrun M
GM
Madsen
Jan Erik
JE
Nordsletten
Lars
L
Aspaas
Silje
S
Aas
Eline
E
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000191:economics* / Q000534:rehabilitation; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000191:economics* / Q000534:rehabilitation; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation