Calculating and comparing value in orthopaedic hip trauma: A systematic review.

Abstract

To evaluate the existing literature on value comparisons between treatment strategies in orthopaedic hip fracture care using real-world clinical data and standardized cost-effectiveness metrics.Materials and Methods. A comprehensive search of PubMed, Embase, and Web of Science was conducted for studies published between January 1, 2003, and May 30, 2024. Only English-language articles were included. Eligible studies directly compared two or more treatment strategies for hip fracture care and included a value-based economic evaluation using clinical (non-simulated) data. Exclusion criteria included simulation models, protocols, case reports, systematic reviews, and meta-analyses. Two independent reviewers screened titles, abstracts, and full texts using PRISMA guidelines. Discrepancies were resolved by a third reviewer. Extracted variables included study design, intervention type, cost perspective, quality metric used, and economic evaluation method. Studies were analyzed descriptively. Outcome measures included cost-effectiveness ratios such as ICER, ICUR, and NMB. QALYs were used to enable cross-study comparisons. Sixteen of 935 screened full-text articles met inclusion criteria. Most studies evaluated surgical interventions. Cemented hemiarthroplasty showed a favorable NMB compared to uncemented implants. Liposomal bupivacaine and tranexamic acid were cost-effective due to lower operating costs and shorter hospital stays. Internal fixation was more cost-effective than hemiarthroplasty in some settings despite lower quality outcomes. Operative treatment in frail, institutionalized patients offered minimal QALY benefit at high cost. Home-based post-acute care and fracture liaison services improved value, while outreach rehab lacked long-term cost-effectiveness. Most studies used public payer perspectives and EQ-5D-derived QALYs. There is significant variability in how value is calculated and reported in hip fracture care. Standardized value frameworks using a hospital/clinic perspective, patient-reported outcomes transformed into QALYs, and cost-utility ratios compared with the ICER equation should be utilized in future studies. Level III (Systematic Review of Comparative Studies).