BJJ - 2026-05-01 - Journal Article
Cost-effectiveness of treatment strategies for non-displaced osteoporotic femoral neck fractures in older adults in Ontario, Canada.
Ruangsomboon P, Huang YQ, Ruangsomboon O, Tam D, Zywiel M, Ravi B, Naimark DMJ
Topics
Key Takeaway
Cemented THA yielded the highest net monetary benefit ($790,784 CAD) and was cost-effective versus internal fixation at an ICER of $127.50 per QALM for non-displaced femoral neck fractures in 65-year-old Canadians.
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Summary
This probabilistic Markov chain Monte Carlo decision analysis compared six treatment strategies for non-displaced osteoporotic femoral neck fractures in a base-case 65-year-old Ontario patient. Cemented THA generated the highest QALMs (192.7) and highest NMB ($790,784 CAD), with an ICER of $127.50 per QALM versus internal fixation—well below the $4,166.67/QALM threshold. Cementless THA, cementless HHA, and conservative treatment were absolutely dominated; cemented HHA was extendedly dominated.
Key Limitation
The base-case cohort is fixed at age 65, limiting direct applicability to the more common octogenarian hip fracture population where arthroplasty complication profiles, life expectancy, and cost-effectiveness thresholds differ substantially.
Original Abstract
AIMS
This economic evaluation study assessed the cost-effectiveness of six treatment strategies for non-displaced osteoporotic femoral neck fractures (NDFNFs) in older adults using a Markov cohort model from the Ontario, Canada, public payer perspective.
METHODS
A probabilistic Markov chain Monte Carlo decision analysis model was developed to compare six strategies: 1) cemented femoral fixation total hip arthroplasty (THA; hybrid, cemented femoral component/uncemented cup - 'cemented THA'); 2) cementless THA; 3) cemented hip hemiarthroplasty (HHA); 4) cementless HHA; 5) internal fixation (IF); and 6) conservative treatment. The base case cohort consisted of Canadian patients presenting with a NDFNF aged 65 years, modelled with a lifetime horizon. Outcomes included quality-adjusted life-months (QALMs), lifetime costs (discounted at 1.5% annually), net monetary benefits (NMBs), and incremental cost-effectiveness ratios (ICERs). All costs are presented in Canadian dollars (CAD, $). The cost-effectiveness threshold (λ) was $4,166.67 per QALM. The primary outcome measure was expected NMBs, and the preferred strategy was the one with the highest expected NMBs over the lifetime horizon.
RESULTS
The estimated mean costs were $6,054 (IF), $11,995 (cemented THA), $11,011 (cemented HHA), $11,854 (cementless HHA), $15,405 (cementless THA), and $7,617 (conservative treatment). Cemented THA yielded the highest QALMs (192.7). Cemented THA had the highest NMB ($790,784). Cementless THA, cementless HHA, and conservative treatment were absolutely dominated while cemented HHA was extendedly dominated. After excluding dominated strategies, the ICER for cemented THA compared with IF was $127.5 per QALM, indicating that cemented THA is cost-effective relative to IF. At a λ of $4,166.67 per QALM, cemented THA was the most cost-effective strategy in 48.7% of simulations, followed by cemented HHA (31.2%) and IF (17.9%).
CONCLUSION
Cemented femoral fixation THA is the most preferred strategy (highest expected NMB at λ) for NDFNFs in 65-year-old patients. When evaluated against a λ of $4,166.67 per QALM, cemented THA outperforms cementless THA, HHA, IF, and conservative treatment.