Is Total Hip Arthroplasty a Cost-Effective Option for Management of Displaced Femoral Neck Fractures? A Trial-Based Analysis of the HEALTH Study.
Journal
Journal of orthopaedic trauma
ISSN: 1531-2291
Titre abrégé: J Orthop Trauma
Pays: United States
ID NLM: 8807705
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
entrez:
7
10
2020
pubmed:
8
10
2020
medline:
22
6
2021
Statut:
ppublish
Résumé
Displaced femoral neck fractures are a significant source of morbidity and mortality and can be treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA). Proponents of THA have argued THA offers lower risk of revision, with improved functional outcomes when compared to HA. To evaluate cost effectiveness of THA compared with HA, a trial-based economic analysis of the HEALTH study was undertaken. Health care resource utilization (HRU) and health-related quality of life (HRQoL) data were collected postoperatively and costed using publicly available databases. Using EuroQol-5 Dimensions (EQ-5D) scores, we derived quality adjusted life years (QALYs). A 1.5% discount rate to both costs and QALYs was applied. Age analyses per age group were conducted. All costs are reported in 2019 Canadian dollars. When compared with HA, THA was not cost-effective for all patients with displaced femoral neck fractures ($150,000/QALY gained). If decision makers were willing to spend $50,000 or $100,000 to gain one QALY, the probability of THA being cost-effective was 12.8% and 32.8%, respectively. In a subgroup of patients younger than 73 (first quartile), THA was both more effective and less costly. Otherwise, THA was more expensive and yielded marginal HRQoL gains. Our results suggest that for most patients, THA is not a cost-effective treatment for displaced femoral neck fracture management versus HA. However, THA may be cost effective for younger patients. These patients experience more meaningful improvements in quality of life with less associated cost because of shorter hospital stay and fewer postoperative complications. Economic Level II. See Instructions for Authors for a complete description of levels of evidence.
Sections du résumé
BACKGROUND
Displaced femoral neck fractures are a significant source of morbidity and mortality and can be treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA). Proponents of THA have argued THA offers lower risk of revision, with improved functional outcomes when compared to HA. To evaluate cost effectiveness of THA compared with HA, a trial-based economic analysis of the HEALTH study was undertaken.
METHODS
Health care resource utilization (HRU) and health-related quality of life (HRQoL) data were collected postoperatively and costed using publicly available databases. Using EuroQol-5 Dimensions (EQ-5D) scores, we derived quality adjusted life years (QALYs). A 1.5% discount rate to both costs and QALYs was applied. Age analyses per age group were conducted. All costs are reported in 2019 Canadian dollars.
RESULTS
When compared with HA, THA was not cost-effective for all patients with displaced femoral neck fractures ($150,000/QALY gained). If decision makers were willing to spend $50,000 or $100,000 to gain one QALY, the probability of THA being cost-effective was 12.8% and 32.8%, respectively. In a subgroup of patients younger than 73 (first quartile), THA was both more effective and less costly. Otherwise, THA was more expensive and yielded marginal HRQoL gains.
CONCLUSIONS
Our results suggest that for most patients, THA is not a cost-effective treatment for displaced femoral neck fracture management versus HA. However, THA may be cost effective for younger patients. These patients experience more meaningful improvements in quality of life with less associated cost because of shorter hospital stay and fewer postoperative complications.
LEVEL OF EVIDENCE
Economic Level II. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 33027164
doi: 10.1097/BOT.0000000000001932
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
S37-S41Investigateurs
Mohit Bhandari
(M)
P J Devereaux
(PJ)
Thomas A Einhorn
(TA)
Frede Frihagen
(F)
Ernesto Guerra-Farfán
(E)
Kenneth J Koval
(KJ)
Rudolf W Poolman
(RW)
Emil H Schemitsch
(EH)
Kevin Tetsworth
(K)
Lehana Thabane
(L)
Stephen D Walter
(SD)
Gordon H Guyatt
(GH)
Mohit Bhandari
(M)
Sheila Sprague
(S)
Paula McKay
(P)
Kim Madden
(K)
Sofia Bzovsky
(S)
Kerry Tai
(K)
Taryn Scott
(T)
Marilyn Swinton
(M)
Naveen Khan
(N)
Diane Heels-Ansdell
(D)
Lisa Buckingham
(L)
Aravin Duraikannan
(A)
Thomas A Einhorn
(TA)
Heather Silva
(H)
Thomas A Einhorn
(TA)
David Novikov
(D)
Daniel P Waren
(DP)
Ydo V Kleinlugtenbelt
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Ellie B M Landman
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Martin J Heetveld
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Rudolf W Poolman
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Esther M M Van Lieshout
(EMM)
Paul T P W Burgers
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Amar Rangan
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Birgit Hanusch
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Lucksy Kottam
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Robert D Zura
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Victoria Avram
(V)
Ajay Manjoo
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John Antoniou
(J)
Tim Ramsay
(T)
Earl R Bogoch
(ER)
Andrew Trenholm
(A)
Stephen Lyman
(S)
Madhu Mazumdar
(M)
Kevin J Bozic
(KJ)
Mark Luborsky
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Stuart Goodman
(S)
Susan Muray
(S)
Benjamin K Potter
(BK)
Diane Heels-Ansdell
(D)
Lehana Thabane
(L)
Nathan N O'Hara
(NN)
Gerard P Slobogean
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Quazi Ibrahim
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Richard Buckley
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Robert Korley
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Paul Duffy
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Shannon Puloski
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Eldridge Batuyong
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Christopher Martin
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Jason Werle
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Kelly Johnston
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Marcia Clark
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Gregory Abelseth
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