Which fixation options are most cost-effective for intertrochanteric hip fractures?
A study published in The Journal of Bone and Joint Disease sought to find the answer. Interochanteric hip fractures accounted for around 7 percent of the osteoporotic fractures and cost around $6 billion per year in the United States.
The researchers estimated total costs and health utility based on the choice of a sliding hip screw or an intramedullary nail for intertrochanteric hip fracture fixation, deriving critical parameters from the literature. The researchers found:
1. Fixation failure rate and implant cost were the most important factors when determining implant choice.
2. The average value for the intramedullary nail was $1,200. When set at the average value, intramedullary nailing had incremental cost-effectiveness ration of $50,000 per quality-adjusted life year if the sliding hip screw incremental failure rate was 1.9 percent.
3. The intramedullary nails dominated with lower cost and better health outcomes when the sliding hip screw incremental failure rate was greater than 5 percent.
4. For a clearly stable fracture, the sliding hip screw was always more cost effective than other options. On the other hand, the intramedullary nail always dominated for clearly unstable fractures.
5. Sliding hip screws were cost effective in 70 percent of the cases for fractures with questionable stability. However, this was highly sensitive to the failure rate.