OBJECTIVES: Surgical treatment is the optimal strategy for managing intertrochanteric hip fractures, we therefore aimed to assess the cost-effectiveness of commonly used intramedullary devices for the treatment of intertrochanteric hip fractures.

METHODS: A decision analytic model was developed from US payer’s perspective using clinical data from a pairwise meta-analysis of randomised controlled trials and comparative observational studies comparing Integrated 2 screw de-rotation cephalomedullary device (2-screw nail versus a traditional single screw cephalomedullary nail (single-screw nail). The model considered a cohort of 1000 patients with a mean age of 77 as reported in the clinical studies over a one year time horizon. Cost data were obtained from published studies and adjusted for inflation and the CMS website. We conducted one way and probabilistic sensitivity analyses to assess the effect of uncertainty in model parameters on our model conclusions.

RESULTS: The meta-analysis showed a significant reduction in implant related failures OR 0.18 (95% CI, 0.06 to 0.52) p=0.002 in the 2-screw derotation nail treated patients and no difference in revisions p=0.20 and non-unions p=0.40. The model estimated 0.566 and 0.565 QALY gained, 0.78 and 0.69 complications avoided for the 2-screw de-rotation nail and single screw nail respectively. The estimated cost/patient was $32,456 and $36,526 for the 2-screw de-rotation nail and single screw nail respectively resulting in cost-saving of $4,071 in favour of the 2-screw de-rotation nail. The findings were robust to a range of sensitivity analyses and the probabilistic SA showed that the probability that the 2-screw de-rotation nail is cost-effective/saving was 99%.

CONCLUSIONS: 2-screw de-rotation nail can be considered a cost saving intervention in reducing complications and improving health related quality of life in patients with intertrochanteric fractures. Providers should consider using 2-screw de-rotation nail to maximise efficiency in this patient population.

* TRIGEN^◊ INTERTAN (Smith & Nephew, Memphis), ** Gamma3™ (Stryker, Kalamazoo, MI)