OBJECTIVES:

A previous randomized controlled trial (RCT) showed a trend towards a lower rate of revision surgery in patients with unstable trochanteric fracture treated with Proximal Femoral Nail Antirotation™ with TRAUMACEM™ V+ Injectable Bone Cement augmentation compared with fixation without augmentation. This study built on results from the RCT to assess the cost-effectiveness of fixation with cement augmentation compared with no augmentation for closed unstable trochanteric fractures from the US healthcare payer's perspective.

METHODS:

A two-stage model was built, a decision tree model that simulated clinical events, costs, and utilities over one year after fixation surgery, followed by a Markov model that extrapolated events over a lifetime horizon. Clinical events probabilities, costs, and utilities were obtained from the previous RCT, published literature, and supplemental clinical and administrative claims data. Costs were adjusted to 2020 US dollars. The effectiveness outcome was quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses were performed.

RESULTS:

In base-case analyses, fixation with augmentation was the dominant strategy, i.e., it was associated with cost savings (−$163.6/patient) and QALY gains (0.02 per patient), resulting in an ICER of -$9'714.1/QALY. ICER was most sensitive to variations in augmentation costs, revision surgery rate, and mortality rate in the decision tree model. In probabilistic sensitivity analyses, fixation with augmentation was associated with lower costs and increased QALYs in 68.1% and 59.8% of the 10,000 simulations, respectively. At willingness-to-pay thresholds of $50,000, $100,000, and $150,000/QALY, the probability of fixation with augmentation being cost-effective was 61.5%, 60.5%, and 60.3%, respectively.

CONCLUSIONS:

Based on an RCT with low revision rates, for unstable trochanteric fractures, fixation with TRAUMACEM V+ Injectable Bone Cement augmentation dominated fixation without augmentation, primarily driven by cost savings. This study can inform policy makers in their decision favoring use of cement augmentation in the fixation of closed unstable trochanteric fractures.