Comparing the posterolateral and the direct lateral approach for cemented hemiarthroplasty after femoral neck fracture: a cost-effectiveness analysis

Acta Orthopaedica, vol. 96, pp. 914–919

Abstract

BACKGROUND AND PURPOSE: The 2 most common surgical approaches in hemiarthroplasty for hip fracture treatment are the posterolateral and the direct lateral approach. We aimed to estimate the relative cost-effectiveness of these approaches. METHODS: We conducted an economic evaluation alongside a randomized controlled superiority trial for 6 months. The trial included 555 patients over 18 years of age with an acute femoral neck fracture. The effectiveness outcome used was quality-adjusted life years (QALYs), assessed using the EQ-5D-5L. Costs were measured through self-reported questionnaires administered at baseline, after 3 months, and after 6 months. We dealt with missing data through multiple imputation and analyzed the imputed datasets by comparing group means in costs and QALYs. A secondary analysis included adjustment for baseline imbalances through linear regression. RESULTS: The estimated average treatment effect on the QALYs was 0.02 (95% confidence interval [CI] -0.006 to 0.046). From the healthcare and societal perspective, we found a non-significant average treatment effect on costs of 1,508 (CI -1,744 to 4,760) and 1,583 (CI -1,972 to 5,137), respectively. The probability of cost-effectiveness was 10% at a willingness-to-pay of zero, and then slowly increased to around 50% for higher willingness-to-pay values. CONCLUSION: We found no conclusive evidence of any differences between the surgical approaches with respect to costs, QALYs, and cost-effectiveness. We therefore suggest that, from an economic viewpoint, the 2 surgical approaches should be treated as interchangeable.

Authors 11

1. Jonas Eßer

   Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Health Sciences, Vrije Universiteit, Amsterdam, the Netherlands. j.esser@vu.nl

2. Maria C J M Tol

   OLVG

   Affiliation as printed

   Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands

3. Nienke Willemien Willigenburg

   OLVG

   Affiliation as printed

   Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands

4. Ariena J. Rasker

   OLVG

   Affiliation as printed

   Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands

5. Taco Gosens

   Tilburg University · Elisabeth-TweeSteden Ziekenhuis

   Affiliation as printed

   Department of Orthopedics and Trauma Surgery, ETZ, Tilburg; Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands

6. Martijn G.M. Schotanus

   Maastricht University · Zuyderland Medisch Centrum · Care and Public Health Research Institute

   Affiliation as printed

   Department of Orthopedic Surgery & Traumatology, Zuyderland Medical Center, Heerlen, Sittard-Geleen; School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands

7. Hanna C. Willems

   Amsterdam University Medical Centers

   Affiliation as printed

   Department of Internal Medicine and Geriatrics, Amsterdam UMC, Amsterdam, the Netherlands

8. Martin J. Heetveld

   Spaarne Gasthuis

   Affiliation as printed

   Department of Trauma Surgery, Spaarne Gasthuis, Haarlem, the Netherlands

9. Johan Carel Goslings

   OLVG

   Affiliation as printed

   Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands

10. Johanna Maria van Dongen

    Vrije Universiteit Amsterdam

    Affiliation as printed

    Department of Health Sciences, Vrije Universiteit, Amsterdam, the Netherlands

11. Rudolf Wilhelm Poolman Aachen

    Leiden University Medical Center · OLVG

    Affiliation as printed

    Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam; Department of Orthopedic Surgery, LUMC, Leiden, the Netherlands