Joeris, A, Kabiri, M, Galvain, T, Vanderkarr, M, Holy, CE, Plaza, JQ, Schneller, J and Kammerlander, C (2024) Nail fixation of unstable trochanteric fractures with or without cement augmentation: A cost-utility analysis in the United States: Cost-utility of cement augmentation. Injury, 55 (4). pp. 1-8. ISSN 0020-1383

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Abstract

Objectives: Recent clinical studies have shown favorable outcomes for cement augmentation for fixation of trochanteric fracture. We assessed the cost-utility of cement augmentation for fixation of closed unstable trochanteric fractures from the US payer's perspective. Methods: The cost-utility model comprised a decision tree to simulate clinical events over 1 year after the index fixation surgery, and a Markov model to extrapolate clinical events over patients’ lifetime, using a cohort of 1,000 patients with demographic and clinical characteristics similar to that of a published randomized controlled trial (age ≥75 years, 83 % female). Model outputs were discounted costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) over a lifetime. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainty on results. Results: Fixation with augmentation reduced per-patient costs by $754.8 and had similar per-patient QALYs, compared to fixation without augmentation, resulting in an ICER of −$130,765/QALY. The ICER was most sensitive to the utility of revision surgery, mortality risk ratio after the second revision surgery, mortality risk ratio after successful index surgery, and mortality rate in the decision tree model. The probability that fixation with augmentation was cost-effective compared with no augmentation was 63.4 %, 58.2 %, and 56.4 %, given a maximum acceptable ceiling ratio of $50,000, $100,000, and $150,000 per QALY gained, respectively. Conclusion: Fixation with cement augmentation was the dominant strategy, driven mainly by reduced costs. These results may support surgeons in evidence-based clinical decision making and may be informative for policy makers regarding coverage and reimbursement.

Item Type:	Article
Uncontrolled Keywords:	Humans; Hip Fractures; Bone Cements; Reoperation; Quality-Adjusted Life Years; Aged; Cost-Benefit Analysis; United States; Surgeons; Bone cement; Cost savings; Cost-utility analysis; Quality-adjusted life years; Reoperation; Trochanteric fracture; Humans; United States; Aged; Cost-Benefit Analysis; Reoperation; Surgeons; Bone Cements; Hip Fractures; Quality-Adjusted Life Years; Women's Health; Clinical Research; Health Services; Cost Effectiveness Research; Patient Safety; Comparative Effectiveness Research; Burden of Illness; 6.4 Surgery; 3 Good Health and Well Being; Humans; United States; Aged; Cost-Benefit Analysis; Reoperation; Surgeons; Bone Cements; Hip Fractures; Quality-Adjusted Life Years; 1103 Clinical Sciences; 1110 Nursing; 1117 Public Health and Health Services; Orthopedics
Subjects:	R Medicine > RD Surgery
Divisions:	Computer Science and Mathematics
Publisher:	Elsevier BV
SWORD Depositor:	A Symplectic
Date Deposited:	19 Dec 2024 13:28
Last Modified:	19 Dec 2024 13:30
DOI or ID number:	10.1016/j.injury.2024.111445
URI:	https://researchonline.ljmu.ac.uk/id/eprint/25131

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