Abstract
BackgroundSurgical treatment is the optimal strategy for managing intertrochanteric fractures as it allows for early rehabilitation and functional recovery. The purpose of the study was to assess the cost-effectiveness of commonly used cephalomedullary nails for the treatment of unstable intertrochanteric hip fractures.MethodsA decision analytic model was developed from a US payer’s perspective using clinical data from a pairwise meta-analysis of randomised controlled trials (RCTs) and comparative observational studies comparing the integrated twin compression screw (ITCS) nail versus two single-screw or blade cephalomedullary nails [single lag screw (SLS) nail and single helical blade (SHB) nail]. The model considered a cohort of 1000 patients with a mean age of 76, as reported in the clinical studies over a 1-year time period. Cost data was obtained from the Center for Medicare and Medicaid Services website and published literature and adjusted for inflation. One-way and probabilistic sensitivity analyses were conducted to assess the effect of uncertainty in model parameters on model conclusions.ResultsThe model estimated 0.546 quality-adjusted life years (QALYs) and 0.78 complications avoided by using the ITCS nail and 0.455 QALYs and 0.67 complications avoided for the standard of care, using SLS or SHB nails. The cost per patient was $34,336 for patients treated with an ITCS nail and $37,036 for patients treated with the standard of care respectively, resulting in a cost saving of $2700 in favour of the ITCS nail. More savings were observed when the ITCS nail was compared to the SHB ($3280 per patient) and SLS ($1652 per patient). The findings were robust to a range of both one-way and the probabilistic sensitivity analyses.ConclusionIn conclusion, the ITCS nail can be considered a cost saving intervention in patients undergoing intertrochanteric fracture fixation with an intramedullary device. Clinicians and policy makers should be encouraged to adopt healthcare technologies such as ITCS that will help them to provide quality healthcare despite falling budgets.
Highlights
Surgical treatment is the optimal strategy for managing intertrochanteric fractures as it allows for early rehabilitation and functional recovery
The base case analysis from the payer’s perspective demonstrated that the integrated twin compression screw (ITCS) nail was associated with lower total mean costs per patient and improved clinical outcomes compared to patients in the standard of care group
The estimated cost savings for the ITCS nail compared to standard of care is estimated to be $2700 per patient per year
Summary
Surgical treatment is the optimal strategy for managing intertrochanteric fractures as it allows for early rehabilitation and functional recovery. The number of fractures is estimated to increase from about 320,000 per year to 580,000 by 2040 in the USA with healthcare costs exceeding $10 billion per year [3,4,5] placing a huge financial burden on patients, families, insurers, hospitals and governments. In the USA, it is estimated that hip fractures account for approximately 14% of all fractures, but impart nearly 70% of the acute hospital care costs associated with fracture treatment [6]. In the UK, the incidence of hip fractures is estimated to be between 70,000 to 75,000 per year, the annual cost is estimated to be over £2 billion and the incidence is predicted to increase to 104,000 by 2025 [2, 8] leading to increasing pressure on the falling healthcare budgets
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
