Cost-Effectiveness of FHR vs PFNA for Basicervical Femoral Neck Fractures in Elderly

Overview

This retrospective study compared the cost-effectiveness of proximal femoral nail antirotation (PFNA) and femoral head replacement (FHR) in patients aged 60 and above with femoral neck basicervical fractures. PFNA demonstrated superior overall cost-effectiveness, while FHR provided faster early functional recovery but at a higher cost exceeding China's willingness-to-pay threshold.

Background

Femoral neck basicervical fractures represent an unstable subtype with distinct anatomical and biomechanical characteristics, leading to higher shear stress and instability compared to other femoral neck fractures. Surgical treatment options primarily include internal fixation (PFNA) and femoral head replacement (FHR). Given the aging population and limited medical resources, understanding the cost-effectiveness of these treatments is crucial for optimizing clinical decision-making. Prior studies have not specifically addressed cost-benefit comparisons for this fracture subtype.

Data Highlights

Key Findings

• PFNA had significantly lower cost-effectiveness ratio (CER) compared to FHR (751.74 vs. 874.60 yuan/point, p=0.002).
• QALY-based CER was lower for PFNA (72,875.25 yuan/QALY) than for FHR (82,761.68 yuan/QALY).
• FHR's incremental cost per QALY gained exceeded China's willingness-to-pay threshold, indicating lower cost-effectiveness overall.
• FHR provided faster early functional recovery compared to PFNA.
• Both PFNA and FHR achieved favorable clinical outcomes in elderly patients with basicervical femoral neck fractures.
• Surgical choice should consider patient-specific factors including fracture displacement, bone quality, and patient priorities such as early ambulation versus cost-effectiveness.

Clinical Implications

Clinicians should consider PFNA as the preferred treatment for elderly patients prioritizing cost-effectiveness and long-term functional recovery. FHR may be more appropriate for patients who require rapid early functional recovery and wish to reduce caregiver burden despite higher costs. Treatment decisions must balance clinical outcomes, patient characteristics, and healthcare resource constraints.

Conclusion

Both PFNA and FHR are effective surgical options for femoral neck basicervical fractures in elderly patients. PFNA offers superior cost-effectiveness, while FHR facilitates faster early recovery, underscoring the need for individualized treatment planning.

References

1. Watson et al. -- Outcomes of cephalomedullary fixation for basicervical fractures
2. Lee et al. -- Risk factors for fixation failure in basicervical fractures treated with PFNA