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Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures

Joeris, A, Kabiri, M, Galvain, T, Vanderkarr, M, Holy, CE, Plaza, JQ, Tien, S, Schneller, J and Kammerlander, C (2022) Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures. Journal of Bone and Joint Surgery: American Volume, 104 (22). pp. 2026-2034. ISSN 0021-9355

Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures.pdf - Published Version
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Open Access URL: https://doi.org/10.2106/JBJS.21.01516 (Published version)


Background:A previous randomized controlled trial (RCT) demonstrated a trend toward a reduced risk of implant-related revision surgery following fixation with use of a Proximal Femoral Nail Antirotation (PFNA) with TRAUMACEM V+ Injectable Bone Cement augmentation versus no augmentation in patients with unstable trochanteric fractures. To determine whether this reduced risk may result in long-term cost savings, the present study assessed the cost-effectiveness of TRAUMACEM V+ cement augmentation versus no augmentation for the fixation of unstable trochanteric fractures from the German health-care payer's perspective.Methods:The cost-effectiveness model comprised 2 stages: a decision tree simulating clinical events, costs, and utilities during the first year after the index procedure and a Markov model extrapolating clinical events, costs, and utilities over the patient's lifetime. Sources of model parameters included the previous RCT, current literature, and administrative claims data. Outcome measures were incremental costs (in 2020 Euros), incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Model uncertainty was assessed with deterministic and probabilistic sensitivity analyses.Results:The base-case analysis showed that fixation with cement augmentation was the dominant strategy as it was associated with cost savings (50.3/patient) and QALY gains (0.01 QALY/patient). Major influential parameters for the ICER were the utility of revision, rates of revision surgery within the first year after fixation surgery, and the costs of augmentation and revision surgery. Probabilistic sensitivity analyses demonstrated that estimates of cost savings were more robust than those of increased QALYs (66.4% versus 52.7% of the simulations). For a range of willingness-to-pay thresholds from 0 to 50,000, the probability of fixation with cement augmentation being cost-effective versus no augmentation remained above 50%.Conclusions:Fixation with use of cement augmentation dominated fixation with no augmentation for unstable trochanteric fractures, resulting in cost savings and QALY gains. Given the input parameter uncertainties, future analyses are warranted when long-term costs and effectiveness data for cement augmentation are available.Level of Evidence:Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.

Item Type: Article
Uncontrolled Keywords: Humans; Hip Fractures; Bone Cements; Reoperation; Quality-Adjusted Life Years; Cost-Benefit Analysis; Humans; Cost-Benefit Analysis; Bone Cements; Quality-Adjusted Life Years; Hip Fractures; Reoperation; 0903 Biomedical Engineering; 1103 Clinical Sciences; Orthopedics
Subjects: Q Science > QA Mathematics > QA76 Computer software
Divisions: Computer Science & Mathematics
Publisher: Lippincott, Williams & Wilkins
SWORD Depositor: A Symplectic
Date Deposited: 15 Dec 2022 10:22
Last Modified: 20 Feb 2023 15:09
DOI or ID number: 10.2106/JBJS.21.01516
URI: https://researchonline.ljmu.ac.uk/id/eprint/18407
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