Internal fixation and hemiarthroplasty for the treatment of displaced femoral neck fracture: a cost-utility analysis

Abstract

Objective: To compare the cannulated screw internal fixation (IF) and hemiarthroplasty (HA) for displaced femoral neck fracture with cost-utility analysis (CUA). Methods: From January 2014 to August 2015, a total of 87 patients above 60 years old with displaced femoral neck fracture were admitted into the study and divided into 2 groups according to surgery type. There were 41 cases in IF group and 46 cases in HA group. During 1 year follow-up we collected the total cost due to fracture and applied EQ-5D index to evaluate the clinical effects. The value of EQ-5D index will be transformed to quality adjusted life year (QALY). Eventually the data including cost and QALY were used to calculate the cost utility ratio (CUR) for patients in each group. Results: All the patients completed the operation successfully. The total cost of IF and HA was 45 796 yuan and 56 657 yuan (P<0.05), while the QALY was 0.79 and 0.83 respectively (P>0.05). The CUR showed that patients in IF and HA group spent 57 970 yuan and 68 261 yuan for each QALY which means patients in HA group spent more 10 292 yuan for each QALY than that in IF group. Conclusions: Both IF and HA can provide satisfactory clinical outcome in 1 year follow-up, however the total cost of IF was obviously less than HA. Therefore IF may be more cost-effective for the treatment of displaced femoral neck fracture in terms of health economics.