A United States Medicare Population-Based Cost-Effectiveness Analysis of Cemented Stem Fixation when Treating Femoral Neck Fractures.

Abstract

The number of hip fractures in the United States (US) continues to increase each year. Current guidelines recommend cemented femoral fixation when performing hemiarthroplasty (HA) and total hip arthroplasty (THA). Yet, over half of femoral neck fractures in older patients are treated with cementless femoral fixation in the US. This study examined the costs and Quality Adjusted Life Years (QALYs) of cemented and cementless femoral fixation for HA and THA procedures at the population level in the US utilizing data from the American Joint Replacement Registry (AJRR). A Markov model was created for 11,339 Medicare patients aged 65 to 74, 75 to 84, and 85-plus years in the AJRR. We simulated the expected impact on costs and health outcomes over five years if all patients received the same femoral fixation method for both HA and THA based on age. Revision, dislocation, and mortality rates, costing data, and health utilities from registry data and published literature were used to populate the model. We simulated outcome uncertainty with probabilistic sensitivity analysis. By switching entirely to cemented fixation, Medicare can achieve annual cost savings for these patients of $5.0 million [95% uncertainty interval (UI): -$0.6 to $8.0 million] and 1,356 [95% UI: -618 to 3,362] quality-adjusted life years. Cost-effectiveness was observed in 92% of simulations. Extrapolated over the annual incidence of hip fractures treated with arthroplasty in the US Medicare population, this could equate to $126.6 million [95% UI: -$15.0 to $201.2 million] in annual cost savings. Cementless fixation remains the dominant mode of fixation for hip fractures in the United States. This cost-effectiveness study suggests potential cost savings and improved quality of life from switching to cemented femoral fixation for femoral neck fractures for both HA and THA, primarily due to lower postoperative complication rates.