Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China, 100045.
Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, China, 100035.
Injury. 2020 Jun;51(6):1346-1351. doi: 10.1016/j.injury.2020.03.002. Epub 2020 Mar 2.
There is little information on the cost and outcome of different treatments for femoral neck fractures. This study aimed to evaluate the cost-effectiveness of internal fixation compared with hemiarthroplasty (HA) for elderly patients with displaced femoral neck fractures.
A total of 121 patients ≥ 65 years old were divided into internal fixation (n = 58) or HA group (n = 63). Clinical outcome was evaluated by the EuroQol 5 dimensions (EQ-5D) score at 3, 12, and 24 months. The total costs including medical and non-medical expense were collected through hospitalisation information, cost diaries, and telephone interviews. A cost-utility analysis of the total costs in combination with quality-adjusted life years (QALYs) calculated by EQ-5D and survival time was conducted. Results were expressed in incremental cost-effectiveness ratio (ICER).
The mean EQ-5D index score in the HA group were higher at the early follow-up (p<0.05). At 24 months there were no differences in EQ-5D between the 2 treatment groups (p>0.05). Over the 2-year period, patients treated with HA gained 0.09-0.10 more QALYs than those treated with internal fixation, while the mean total costs for internal fixation (CNY 55,676) were significantly lower than for HA (CNY 80,297) (P<0.001). ICER indicated that internal fixation may be more cost-effective than HA.
HA is associated with better outcome than internal fixation in the treatment of displaced femoral neck fractures in elderly patients. However, internal fixation may be more cost-effective because of less total cost.
对于股骨颈骨折的不同治疗方法的成本和结果，相关信息较少。本研究旨在评估与人工髋关节置换术（HA）相比，内固定治疗老年移位股骨颈骨折的成本效益。
共纳入 121 名年龄≥65 岁的患者，分为内固定（n=58）或 HA 组（n=63）。通过 EuroQol 5 维度（EQ-5D）评分在 3、12 和 24 个月时评估临床结果。通过住院信息、费用日记和电话访谈收集包括医疗和非医疗费用在内的总费用。通过 EQ-5D 计算的总费用和生存时间结合质量调整生命年（QALYs）进行成本效用分析。结果表示为增量成本效益比（ICER）。
HA 组的平均 EQ-5D 指数在早期随访时较高（p<0.05）。在 24 个月时，两组之间的 EQ-5D 没有差异（p>0.05）。在 2 年期间，HA 治疗的患者比内固定治疗的患者获得 0.09-0.10 个更多的 QALYs，而内固定治疗的总费用（CNY 55676）明显低于 HA 治疗（CNY 80297）（P<0.001）。ICER 表明，与 HA 相比，内固定可能更具成本效益。
HA 治疗老年移位股骨颈骨折的效果优于内固定，但由于总费用较低，内固定可能更具成本效益。
