Alolabi Bashar, Bajammal Sohail, Shirali Janhavi, Karanicolas Paul J, Gafni Amiram, Bhandari Mohit
Department of Surgery, University of Western Ontario, Ontario, Canada.
J Orthop Trauma. 2009 Jul;23(6):442-6. doi: 10.1097/BOT.0b013e31817614dd.
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.
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.
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.
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.
老年患者移位型股骨颈骨折的最佳治疗方法存在争议。与半髋关节置换术（HA）相比，内固定术（IF）手术创伤、出血量较少，可能死亡率也较低，但代价是再次手术率较高，且可能成本增加。
我们从第三方支付方的角度估算了60岁以上患者股骨颈骨折两种治疗策略（HA和IF）1年后的成本。使用决策板，我们了解了患者对这两种手术方法的偏好，并使用支付意愿技术计算了净效益。
1次IF的1年预计成本为18,100美元，1次HA的成本为15,843美元（每次IF的增量成本为2257美元）。在108名参与者中，61人（56.5%）选择IF作为首选治疗方案，并愿意在需要时每月平均支付3.33美元以获得该方案。在安大略省，选择IF的患者进行IF的总增量成本为64,714,103美元，社会总效益为289,263,600美元，净效益为224,549,497美元。
从第三方支付方的角度来看，IF相对于HA的益处超过了增量成本。应向选择IF的患者提供该治疗方法。
