OBJECTIVES: Intertrochanteric hip fractures are common especially for the elderly and surgical treatment is the optimal strategy for managing these fractures. The relative effects of internal fixation strategies for intertrochanteric fractures remain limited to relatively small studies which create uncertainty in attempts to establish evidence-based best practice. We aimed to assess the cost-effectiveness of 2 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 a 2-screw nail versus a 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 was obtained from published studies and adjusted for inflation and the CMS website. We conducted one way and probabilistic sensitivity analyses.

RESULTS: The meta-analysis showed a significant reduction in implant-related failures in favour of the 2-screw nail Odds Ratio; 0.07 (95% CI, 0.01 to 0.39, p = 0.002). The model estimated 0.566 and 0.563 QALY gained and 0.79 and 0.62 complications avoided for the 2-screw nail and single-screw nail respectively. The estimated cost/patient was $32,503 and $38,233 for the 2-screw nail and single-screw nail respectively resulting in cost-saving of $5,730 in favour of the 2-screw nail. The findings were robust to a range of sensitivity analyses and the probabilistic SA showed that the probability that the 2-screw nail is cost-effective/saving in 100% of the 2000 simulations.

CONCLUSIONS: * TRIGEN^◊ INTERTAN (Smith & Nephew, Memphis), ** Proximal Femoral Nail Antirotation™ (Synthes, Solothurn, Switzerland)