Cost-utility analysis of cemented hemiarthroplasty versus hydroxyapatite-coated uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures

Abstract

Aims The aim of this study was to compare the cost-effectiveness of cemented hemiarthroplasty (HA) versus hydroxyapatite-coated uncemented HA for the treatment of displaced intracapsular hip fractures in older adults. Methods A within-trial economic evaluation was conducted based on data collected from the World Hip Trauma Evaluation 5 (WHiTE 5) multicentre randomized controlled trial in the UK. Resource use was measured over 12 months post-randomization using trial case report forms and participant-completed questionnaires. Cost-effectiveness was reported in terms of incremental cost per quality-adjusted life year (QALY) gained from the NHS and personal social service perspective. Methodological uncertainty was addressed using sensitivity analysis, while decision uncertainty was represented graphically using confidence ellipses and cost-effectiveness acceptability curves. Results The base-case analysis showed that cemented implants were cost-saving (mean cost difference -£961 (95% confidence interval (CI) -£2,292 to £370)) and increased QALYs (mean QALY difference 0.010 (95% CI 0.002 to 0.017)) when compared to uncemented implants. The probability of the cemented implant being cost-effective approximated between 95% and 97% at alternative cost-effectiveness thresholds held by decision-makers, and its net monetary benefit was positive. The findings remained robust against all the pre-planned sensitivity analyses. Conclusion This study shows that cemented HA is cost-effective compared with hydroxyapatite-coated uncemented HA in older adults with displaced intracapsular hip fractures. Cite this article: Bone Joint J 2022;104-B(8):922–928.

What’s New in Orthopaedic Trauma

“…A within-trial economic evaluation of an RCT performed in the U.K. National Health System estimated the cost-effectiveness of HA performed with cement. This study suggested a 95% to 97% probability of cemented implants being cost-effective 13 . Thus, HA performed with cement for displaced femoral neck fractures should strongly be considered.…”

Infection after intracapsular femoral neck fracture – does antibiotic-loaded bone cement reduce infection risk after hemiarthroplasty and total hip arthroplasty?

“… 31 In addition to cost savings, a statistically significantly increased quality of life has been reported for patients with cemented implants in the World Hip Trauma Evaluation 5 (WHiTE 5) trial. 33 Therefore, a clear clinical recommendation for the application of antibiotic-loaded bone cement in cemented THA and HA for the prevention of PJI is given. The introduction of an interdisciplinary board with clear guidelines has been established to optimize postoperative outcomes after femoral neck fracture and to speed up the decision-making process for treatment.…”

What’s New in Hip Surgery

“…The cost-utility of cemented implants and cementless implants used in hemiarthroplasty for displaced intracapsular hip fractures was investigated using economic data collected within the World Hip Trauma Evaluation 5 (WHiTE 5) trial 6 . The investigators reported that cemented implants were cost-saving (mean cost difference, –£961 [95% CI, –£2,292 to £370]) and increased quality-adjusted life-years (mean quality-adjusted life-year difference, 0.010 [95% CI, 0.002 to 0.017]) when compared with uncemented implants.…”