Cost-effectiveness Analysis On PFNA Versus FHR For Unstable Intertrochanteric Fractures In The Elderly

Objective:The cost-benefit analysis of the two operation methods of antirotation intramedullary nail at proximal femur and artificial femoral head replacement was carried out with the method of health economics,which provided a basis for the more reasonable choice of surgical plan for the treatment of senile unstable intertrochanteric fracture from the perspective of health economics.Methods:A retrospective study was done on 126 patients who were surgically treated for unstable femoral intertrochanteric fractures from January 2016 to April 2018 in our hospital.In term of the surgical procedure performed,65 patients received PFNA,while the remaining 61 patients underwent FHR.The cost of fractures within 1 year was evaluated by the function recovery scale(FRS)of hip fracture,and the cost-effectiveness ratio and incremental cost-effectiveness ratio were compared between the two groups.Results:Although no statistically significant differences were noted regarding preoperative preparation time and hospital stay between them(P>0.05).the PFNA proved significantly superior to the FHR group in operation time and intraoperative blood loss(P<0.05).However,the PFNA group had significantly lower FRS score than the FHR group at 3 and 6 months after operation.The total cost for treatment in a year in the PFNA was significantly lower than that in the FHR group [(50707.61±9160.07)yuan vs(59429.91±24783.98)yuan,P<0.05],while the FRS score at 1 year postoperatively in the PFNA group was also lower than the FHR group regardless of no a statistically significant difference [(72.64 ± 7.85)vs(75.01±6.25),P>0.05].The average cost per point of FRS score was 698.07 yuan in the PFNA group,whereas 792.29 yuan in the FHR group.Compared between the PFNA group and the FHR group,each extra point of FRS score cost 3680.30 yuan.Conclusion:Both the proximal femoral nail anti-rotation and artificial femoral head replacement do achieve satisfactory results for unstable intertrochanteric fractures in the elderly.However,the cost of PFNA is lower,which may be more efficient in the perspective of health economics.