title: 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.
abstract: 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.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  Hemiarthroplasty was a cost-effective treatment. Trial registration, NCT00464230.
authors: Department of Health Management and Health Economics, University of Oslo, 1089, Blindern, 0317, Oslo, Norway. gudrunmw@medisin.uio.no
authors: G M
authors: GM
authors: Waaler Bjørnelv
authors: F
authors: F
authors: Frihagen
authors: J E
authors: JE
authors: Madsen
authors: L
authors: L
authors: Nordsletten
authors: E
authors: E
authors: Aas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D001863:Bone Screws / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D005265:Femoral Neck Fractures / Q000191:economics* / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000191:economics* / Q000379:methods; D006801:Humans; D016268:Internal Fixators / Q000191:economics; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D016896:Treatment Outcome