Author(s)
Joeris A1, Kabiri M2, Galvain T2, Vanderkarr M3, Holy CE4, Quintana Plaza J5, TIen S6, Schneller J7, Kammerlander C8
1Clinical Science, AO Innovation Translation Center, Davos, Switzerland, 2Global Provider and Payer Value Demonstration, Global Health Economics, Johnson & Johnson Medical Devices, New Brunswick, NJ, USA, 3DePuy Synthes, Inc., West Chester, PA, USA, 4Medical Device Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA, 5Medical Devices, Johnson & Johnson, Madrid, Spain, 6Global Provider and Payer Value Demonstration, Global Health Economics, Johnson & Johnson Medical Devices, Markham, Canada, 7Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany, 8AUVA TraumaHospital Styria, Graz, Austria
OBJECTIVES In a previous randomized controlled trial (RCT), a trend toward lower risk of revision surgery was observed among patients with unstable trochanteric fractures implanted with Proximal Femoral Nail Antirotation (PFNA) with cement augmentation versus without augmentation. This potential benefit may translate into long-term cost savings. This study assessed the cost-effectiveness of treating unstable trochanteric fractures with PFNA with versus without cement augmentation from the German healthcare payer's perspective. METHODS We built a two-stage cost-utility model consisting of a decision tree that simulated clinical events, costs, and utilities over one year after index surgery followed by a Markov model to extrapolate events over a lifetime horizon. The model was populated with data from the previous RCT, published literature, and supplemental clinical and administrative claims data. Costs were adjusted to 2020 euros. Effectiveness was measured in quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses were conducted to assess model uncertainty. RESULTS In the base-case analysis, PFNA with augmentation was associated with lower costs (−€105/ patient) and higher effectiveness (0.01 QALY/patient) than without augmentation. PFNA with augmentation was the dominant strategy with an incremental cost-effectiveness ratio (ICER) of −€7,182/QALY. Major influential parameters for the ICER were mortality rate, revision rate, augmentation costs, and revision surgery costs. In the probabilistic sensitivity analysis, PFNA with augmentation was associated with lower costs and increased QALYs in 85% and 60% of the iterations, respectively. The cost-effectiveness acceptability curve showed that PFNA with augmentation was more likely to be cost-effective than without augmentation regardless of the willingness-to-pay threshold. CONCLUSIONS Based on an RCT with low revision rates, PFNA with augmentation moderately dominated PFNA without augmentation, leading to cost savings and more QALYs. Future research should evaluate if PFNA with augmentation is more cost-effective among the subgroup of patients with higher risk of revision surgery.
Conference/Value in Health Info
2021-11, ISPOR Europe 2021, Copenhagen, Denmark
Value in Health, Volume 24, Issue 12, S2 (December 2021)
Code
POSA42
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Trial-Based Economic Evaluation
Disease
Injury and Trauma, Medical Devices, Musculoskeletal Disorders, Surgery
