Graduate School of Health Management, Keio University, Kanagawa, Japan.
Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan.
PLoS One. 2024 Oct 29;19(10):e0310974. doi: 10.1371/journal.pone.0310974. eCollection 2024.
For older patients with displaced femoral neck fractures, in which primary osteosynthesis is usually not indicated, there are three primary prosthetic options-bipolar hemiarthroplasty (BHA), single-bearing total hip arthroplasty (SB-THA), and dual-mobility THA (DM-THA). However, the optimal choice for managing displaced femoral neck fractures remains controversial. Accordingly, this study aimed to evaluate the cost-effectiveness of BHA, SB-THA, and DM-THA in active older patients with displaced femoral neck fractures. A decision tree combined with a Markov model was employed to analyze the cost and quality-adjusted life years (QALYs) of BHA, SB-THA, and DM-THA for the management in the Japanese healthcare system. By simulating the five-year trajectory of a 75-year-old woman treated for a displaced femoral neck fracture, the cost-effectiveness of the three surgical options was evaluated. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to assess parameter uncertainty. Additionally, two scenario analyses were conducted for other settings. The treatment was considered to be cost-effective when the incremental cost-effectiveness ratio (ICER) was below the 5,000,000 yen/QALY threshold. Compared with BHA, SB-THA exhibited higher costs but greater health benefits, resulting in an ICER of 1,499,440 yen/QALY. DM-THA offered additional health benefits compared with SB-THA, with an ICER of 4,145,777 yen/QALY. One-way sensitivity analysis revealed some influential parameters. PSA indicated that the probability of DM-THA, SB-THA, and BHA being cost-effective was 40.1%, 38.5%, and 21.4%, respectively. SB-THA was more cost-effective than BHA in patients aged 65-85 years, while DM-THA was more cost-effective than SB-THA in patients aged 65-75 years. The results suggest that SB-THA is a cost-effective alternative to BHA for displaced femoral neck fractures in active older patients, whereas DM-THA is more cost-effective than SB-THA in relatively younger patients. It is, therefore, recommended that orthopedic surgeons select the most appropriate surgical option based on the individual patient's physiological age.
对于股骨颈骨折移位的老年患者，通常不建议进行初次内固定治疗，有三种主要的假体选择：双极半髋关节置换术（BHA）、单轴承髋关节置换术（SB-THA）和双动髋关节置换术（DM-THA）。然而，对于股骨颈骨折移位的最佳治疗选择仍存在争议。因此，本研究旨在评估在股骨颈骨折移位的活跃老年患者中，BHA、SB-THA 和 DM-THA 的成本效益。采用决策树结合 Markov 模型分析了日本医疗保健系统中 BHA、SB-THA 和 DM-THA 治疗股骨颈骨折的成本和质量调整生命年（QALYs）。通过模拟一位 75 岁女性股骨颈骨折的五年轨迹，评估了三种手术方案的成本效益。采用单因素敏感性分析和概率敏感性分析（PSA）来评估参数不确定性。此外，还进行了两种方案分析。当增量成本效益比（ICER）低于 500 万日元/QALY 阈值时，认为治疗具有成本效益。与 BHA 相比，SB-THA 具有更高的成本，但带来更大的健康收益，ICER 为 149.944 万日元/QALY。与 SB-THA 相比，DM-THA 提供了额外的健康收益，ICER 为 414.5777 万日元/QALY。单因素敏感性分析显示了一些有影响力的参数。PSA 表明，DM-THA、SB-THA 和 BHA 具有成本效益的概率分别为 40.1%、38.5%和 21.4%。在 65-85 岁的患者中，SB-THA 比 BHA 更具成本效益，而在 65-75 岁的患者中，DM-THA 比 SB-THA 更具成本效益。结果表明，对于活动能力较高的老年股骨颈骨折患者，SB-THA 是 BHA 的一种具有成本效益的替代方案，而在相对年轻的患者中，DM-THA 比 SB-THA 更具成本效益。因此，建议骨科医生根据患者的生理年龄选择最合适的手术方案。
