Varady Nathan H, Oeding Jacob F, Gausden Elizabeth B, Ricci William M, Chen Antonia F
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J Arthroplasty. 2025 May;40(5):1239-1245. doi: 10.1016/j.arth.2024.10.098. Epub 2024 Oct 24.
While there is growing scientific evidence supporting superior outcomes following cemented versus uncemented hip hemiarthroplasty (HHA) in elderly femoral neck fractures (FNFs), the relative cost-effectiveness of this in the United States is unknown. Thus, the purpose of this study was to compare the cost-effectiveness of cemented versus uncemented HHA for the treatment of FNFs in patients > 60 years old in the United States, accounting for postoperative outcomes including periprosthetic fractures.
A Markov model utilizing Monte Carlo microsimulation was developed to evaluate the outcomes and costs of patients at least 60 years of age (mean ± SD, 84 ± 8 years) undergoing cemented versus uncemented HHA for the treatment of FNFs. Health utility values, transition probabilities, and upfront costs were derived from the published literature. Outcome measures included average total costs associated with each treatment (including those from patients who sustained a periprosthetic fracture), quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio.
Mean total costs resulting from cemented and uncemented HHA were $19,462 ± 3,581 and $21,997 ± 3,574, respectively, (upfront costs from the published literature were $18,267 for cemented HHA and $16,803 for uncemented HHA). Average QALYs resulting from cemented and uncemented HHA were 4.0 ± 0.7 and 3.1 ± 0.6. The resulting incremental cost-effectiveness ratio was -$2,688.9/QALY. Cemented HHA was found to be the most cost-effective treatment strategy in 89% of the patients in the Monte Carlo microsimulation model.
Despite documented higher upfront costs for cemented HHA, the averaged total costs over a 10-year time horizon were $2,534 less for cemented HHA than for uncemented HHA. In addition, cemented HHA resulted in an additional 0.9 QALYs relative to uncemented HHA. The findings of this US-based study replicate the financial and quality-of-life benefits of cemented HHA for elderly FNFs seen in other health systems.
虽然越来越多的科学证据支持在老年股骨颈骨折（FNF）患者中，骨水泥型与非骨水泥型半髋关节置换术（HHA）相比有更好的治疗效果，但在美国其相对成本效益尚不清楚。因此，本研究的目的是比较美国60岁以上患者骨水泥型与非骨水泥型HHA治疗FNF的成本效益，并考虑包括假体周围骨折在内的术后结果。
建立一个利用蒙特卡洛微观模拟的马尔可夫模型，以评估至少60岁（平均±标准差，84±8岁）接受骨水泥型与非骨水泥型HHA治疗FNF患者的治疗效果和成本。健康效用值、转移概率和前期成本均来自已发表的文献。结果指标包括每种治疗的平均总成本（包括发生假体周围骨折患者的成本）、质量调整生命年（QALY）和增量成本效益比。
骨水泥型和非骨水泥型HHA的平均总成本分别为19,462±3,581美元和21,997±3,574美元（已发表文献中的前期成本：骨水泥型HHA为18,267美元，非骨水泥型HHA为16,803美元）。骨水泥型和非骨水泥型HHA的平均QALY分别为4.0±0.7和3.1±0.6。由此得出的增量成本效益比为 -2,688.9美元/QALY。在蒙特卡洛微观模拟模型中，89%的患者中骨水泥型HHA被认为是最具成本效益的治疗策略。
尽管有记录表明骨水泥型HHA的前期成本较高，但在10年的时间范围内，骨水泥型HHA的平均总成本比非骨水泥型HHA少2,534美元。此外，与非骨水泥型HHA相比，骨水泥型HHA还带来了额外的0.9个QALY。这项基于美国的研究结果重现了在其他卫生系统中观察到的骨水泥型HHA对老年FNF患者的经济和生活质量益处。
