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Gaceta Sanitaria
versión impresa ISSN 0213-9111
Resumen
LARRANAGA, Igor et al. Stratified cost-utility analysis of total hip arthroplasty in displaced femoral neck fracture. Gac Sanit [online]. 2022, vol.36, n.1, pp.12-18. Epub 11-Abr-2022. ISSN 0213-9111. https://dx.doi.org/10.1016/j.gaceta.2021.02.006.
Objective
To conduct a stratified cost-utility analysis of total versus partial hip arthroplasty as a function of clinical subtype.
Method
All cases of this type of intervention were analysed between 2010 and 2016 in the Basque Health Service, gathering data on clinical outcomes and resource use to calculate the cost and utility in quality-adjusted life years (QALYs) at individual level. The statistical analysis included applying the propensity score to balance the groups, and seemingly unrelated regression models to calculate the incremental cost-utility ratio and plot the cost-effectiveness plane. The interaction between age group and American Society of Anesthesiologists (ASA) risk class was assessed in the multivariate analysis.
Results
The study identified 5867 patients diagnosed with femoral neck fracture, of whom 1307 and 4560 were treated with total and partial hip arthroplasty, respectively. In the cost-utility analysis based on the seemingly unrelated regression, total hip arthroplasty was found to have a higher cost and higher utility (2465€ and 0.42 QALYs). Considering a willingness-to-pay threshold of €22,000 per QALY, total hip arthroplasty was cost-effective in the under-80-year-old subgroup. Among patients above this age, hemiarthroplasty was cost-effective in ASA class I-II patients and dominant in ASA class III-IV patients.
Conclusions
Subgroup analysis supports current daily clinical practice in displaced femoral neck fractures, namely, using partial replacement in most patients and reserving total replacement for younger patients.
Palabras clave : Cost-effectiveness; Cost-utility; Displaced femoral neck; Hip replacement; Total hip arthroplasty; Hemiarthroplasty.