Department of Health Management and Health Economics, University of Oslo, 1089, Blindern, 0317, Oslo, Norway.
Osteoporos Int. 2012 Jun;23(6):1711-9. doi: 10.1007/s00198-011-1772-1. Epub 2011 Oct 14.
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.
Estimating the cost utility of hemiarthroplasty compared to internal fixation in the treatment of displaced femoral neck fractures in the elderly.
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.
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.
Hemiarthroplasty was a cost-effective treatment. Trial registration, NCT00464230.
评估人工髋关节置换术与内固定治疗老年移位型股骨颈骨折的成本效果。
在挪威一所大学附属医院进行了一项与临床随机对照试验相结合的成本效果分析（CUA）；共有 166 名患者（124 名女性，平均年龄 82 岁）参与了该研究，其中 86 名患者被随机分配至内固定组，80 名患者被随机分配至人工髋关节置换术组。患者分别在 4、12 和 24 个月时接受随访。采用 EQ-5D 评估健康相关生活质量，并结合使用时间计算患者的质量调整生命年（QALY）。确定、量化并评估了直接和间接医院资源的使用和社会资源的使用，以计算成本。结果以增量成本效果比表示。
在 2 年期间，接受人工髋关节置换术治疗的患者比接受内固定治疗的患者获得了 0.15-0.20 个 QALY 的增益。与内固定组相比，人工髋关节置换术组的直接医院成本、总医院成本和总费用均显著降低，增量成本为 2731 欧元（p=0.81）、2474 欧元（p=0.80）和 14160 欧元（p=0.07）。因此，人工髋关节置换术是一种更具成本效益的治疗方法。通过 bootstrap 进行的敏感性分析支持了这些发现。
人工髋关节置换术是一种具有成本效益的治疗方法。试验注册：NCT00464230。
