FHR vs. PFNA for femoral neck basicervical fractures in elderly patients 60 years or older: a cost-effectiveness analysis from hospitals in western China under the background of medical insurance - Scorecard - MDSpire
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FHR vs. PFNA for femoral neck basicervical fractures in elderly patients 60 years or older: a cost-effectiveness analysis from hospitals in western China under the background of medical insurance
Clinical Scorecard: Comparative Cost-Effectiveness of FHR and PFNA Treatments for Basicervical Femoral Neck Fractures in Patients Aged 60 and Above: Insights from Western Chinese Hospitals within a Medical Insurance Framework
At a Glance
Category
Detail
Condition
Basicervical femoral neck fractures in elderly patients (≥60 years)
Key Mechanisms
Basicervical fractures are unstable with higher shear stress but better healing potential than other femoral neck fractures; treatment options include PFNA (internal fixation) and FHR (femoral head replacement)
Target Population
Patients aged 60 years or older with fresh basicervical femoral neck fractures
Care Setting
Hospital inpatient surgical care within a medical insurance framework in Western China
Key Highlights
PFNA demonstrated lower cost-effectiveness ratio (CER) and QALY-based CER compared to FHR after propensity score matching.
FHR provided faster early functional recovery but incurred higher costs exceeding China's willingness-to-pay threshold for most patients.
Surgical choice should balance cost-effectiveness, early recovery needs, and patient-specific factors such as fracture displacement, comminution, bone quality, and activity expectations.
Guideline-Based Recommendations
Diagnosis
Diagnose basicervical femoral neck fractures via preoperative X-ray and CT imaging.
Classify fractures using Garden classification and assess comminution and bone quality (e.g., T-score).
Management
Select FHR for Garden III/IV displaced fractures, severe comminution (≥3 fragments), poor bone quality (T-score ≤ −2.5), or patients prioritizing rapid functional recovery.
Select PFNA for Garden I/II minimally displaced fractures, minimal comminution, contraindications to arthroplasty, or patients prioritizing cost-effectiveness and long-term recovery.
Perform early surgical treatment within 72 hours of injury to reduce mortality and complications.
Monitoring & Follow-up
Evaluate functional recovery using Functional Recovery Score (FRS) and quality of life with EQ-5D-5L scales.
Conduct follow-up to assess long-term outcomes and revision rates, ideally over 5 years or longer.
Risks
Consider higher surgical failure risk associated with unstable basicervical fractures.
Monitor for potential complications related to surgical choice, including revision surgery and caregiver burden.
Patient & Prescribing Data
Elderly patients (≥60 years) with fresh basicervical femoral neck fractures undergoing PFNA or FHR surgery
PFNA is more cost-effective overall with favorable long-term outcomes; FHR offers faster early functional recovery but at higher cost, suitable for patients prioritizing early ambulation and reduced caregiver burden.
Clinical Best Practices
Use propensity score matching to balance baseline characteristics when comparing treatment outcomes.
Incorporate patient-specific factors such as fracture displacement, comminution, bone quality, and activity level into surgical decision-making.
Balance cost-effectiveness with functional recovery goals to optimize individualized treatment plans.
Plan prospective multicenter studies with longer follow-up to evaluate long-term revision costs and validate findings.
Account for indirect costs and minimize selection bias in future research.
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